Duty to Treat?

After reading this article and discussing many points in small groups about it, I still think it is difficult to create a definition with specific instances that health care providers are required to treat and when it is okay for them to back away from a situation. I know that when I decided that I wanted to be a physician, I did think about the risks that I will expose myself to. I remember talking to a recently graduated physician who was thinking about the new responsibility he had. He was wondering what would happen if he was in an airplane and somebody asked if a physician was on board how he would be able to respond. With just four years of training and not much independent care for patients, would he be able to do good, or would he fail and then be liable for any damage he did. It is a valid question, but I can’t help but think that there is an obligation to treat, even with the risk of making a mistake. With four years of intense learning and training, we as physicians will have a much greater ability to treat a person than somebody who is not a physician. In the times of emergencies, I think that it is a moral duty (not a moral option) for us as physicians to respond to the situation.

I thought it was very interesting to discuss the way that physicians and health care providers can be pushed out of their comfort zone or realm of expertise in an emergency. Part of the oath that we took at our white coat ceremony says that we with “Accept responsibility only for those matters for which I am competent”. In a normal, non-emergent situation, I think this rule always applies. In an emergency, this may have to change a bit. If we fail to act as physicians, we are not using the skills and knowledge that we have worked so hard to gain. Although it is a challenge to step up and care for patients in extreme situations and put our own lives in danger, we signed up for this challenge. The article points out that we “freely chose to become health professionals”. We didn’t sign up for just the good stuff, and I pretty sure that none of us thought it would be easy. We knew the expectations and it is our duty to fulfill them.

There has to be some limit to care in most situations, but for each one, the point at which the duty changes is probably different. I don’t think it is possible to come up with and discuss every type of emergency and exception to duty to treat. However, I think that the article did point out some very good points. One of them is in the AMA code of ethics. It says that a physician should not put themselves in a position that would risk their ability to care for more patients. It seems that in a crisis, the suggestion is to take on a utilitarian point of view; doing the greatest amount of good for the greatest number of people. I think that as a physician, we are responsible to decide when this comes into play. We must know our limits and when they are exceeded when treating will inhibit our ability to continue treating other future patients, we may have to rethink our desire to continue acting.

This topic is very difficult to tackle because I would like to think that in an emergency situation I will act appropriately and that I will make the sacrifices necessary to fulfill my obligations as a physician, but I don’t know how I will really react. We can through out hundreds of hypothetical situations and answer them, but I think that the responses may be different because the emotions that go into such decisions do not come into play in the hypothetical realm. In order to know how people will really react in times of crisis, we need to actually be in times of crisis and observe how people respond. I hope that if I am faced with a precarious situation, I will respond by fulfilling my professional duty and taking care of patients to the best of my ability. I want to make the right decisions, and I hope that my emotions would not prevent me from making the best decisions.

Seven Deadly Sins - Envy

At times this article seemed jam packed with examples of each sin and I had a difficult time finding ways to relate the idea of professionalism into each of those seven sins. However, the author usually pulled together the main idea by the end of each section and I was able to relate each sin, good or bad, to a recommendation on how I should want to be as a physician. The one that caught my attention the most was the sin of Envy.

The section had numerous stories about times that the author thought that he wanted what somebody else had only to find out later, that the person he envied didn't really have life better off than him. In the end, the conclusion was that life would be better off if we would just stop comparing ourselves to others. The last comparison was a positive experience of a patient who never complained about his situation even though he was dying and the life he was living was not much of one. They author looked at the man and seemed to wonder why the patient did not envy those who were in better situations. It got me to thinking how many times as a future physician I will see people that are not as well off as me, whether it be emotionally, physically, or financially. I think that the opposite of envy could be pity......feeling sorry for somebody based on their situation. It's almost as if by pitying somebody you are trying to acknowledge that they are jealous of you. I know that I am going to encounter patients who will inspire me with their attitudes in the face of adversity and I hope that I can learn to be more like them rather than picturing them being jealous of me or somebody else. Based on the definition that Dr. Ring gave in the previous article about professionalism meaning to put the patient first, we can be professional by avoiding pity. I want to remember to put myself in other people's shoes to empathize with them and therefore hopefully be able to treat them with more compassion. I don't want to walk around thinking that people want to walk in my shoes, as if I have something to envy. I want to live a life, and a practice without comparisons. If we take the advice of the author and not make comparisons that put one person's life on a pedestal and the other in a pit, we will be able to be better overall physicians.

Professionalism as Defined by Dr. Ring

In Ring's Presidential Address, professionalism seemed to tie into all of his goals for the "new" AMA starting this year. I think that putting the patient first is ultimately the best way to ensure that professionalism is met. In other professions, I don't think that "professionalism" could be defined in quite the same way. When I think about Dr. Ring's definition of competence, compassion, and moral accountability, I feel like they fit with what I would expect of myself as a physician acting professionally. He also stated towards the end of the article that being professional also meant sacrifices, which is not always easy. I personally agree with these definitions of professionalism and I know that I chose this profession. I want to be compassionate and giving of myself. I know that I will have to sacrifice to be the best physician I can for my patients. I do think that doctors are somewhat set apart from other professionals in the definition that Dr. Ring has given. If I were asked to define professionalism for a person that works in another field, for example, accounting, professionalism may mean following moral obligations to not cheat people of their money, showing up for work on time, and working well with other members of their work team. I just don't picture asking an accountant to sacrifice all personal obligations in order to save a person's taxes. (I do however have a great respect for accountants and admire their ability to do well with the difficult mess of numbers they are often given.) I know that I signed up for this profession, knowing that the stereotypes about personal sacrifice and putting others first is part of the job. I am excited for those aspects of medicine, although they do seem quite daunting when I think about what the mean for my future.

One very interesting phrase that caught my attention towards the end of the article is when Dr. Ring posed the question of whether we "are we a profession to which business is incidental or a business to which our professionalism is incidental?" It really got me thinking about which way I would phrase it with regards to my own life. I know that, especially with the way our current health care system is managed, that business management cannot be ignored. I do not believe that the business management should be the core focus of providing medical care. We should strive to put the medicine first and take care of the business end out of necessity of continuing to deliver great care.

Picking Sides for Obesity in Physicians Article

The article and responses that were a part of this reading assignment pointed out many key arguments for positions on physicians and obesity. Although I don't consider myself in the best physical condition that I could be, I do agree that physicians should control their obesity in order to set a good example for their patients. The best way to gain credibility and acceptance of recommendations from a patient is to carry out the things they ask you to yourself. Before I even got to the argument about cigarettes, I was planning on using it as an example because it was the first thing that came to my mind. Health Systems such as SMDC have made smoking bans on a large radius surrounding the campus and have given other incentives for health care providers to make responsible choices.

Why can't similar programs be put in place for diet and exercise? Often, residents working long hours are given their meals in the cafeteria. While its a quick meal that saves on making a lunch or dinner at home, the choices are often limited, with most of the fresh produce available only during the daytime hours. At 2:00 after working all night without a break, the only foods left are dried up pizza and a corn dog. If hospitals worked to have better food programs for their employees and made greasy foods further away, they may be able to provide incentives for eating better. I know I often buy the junk food because its closer and easier and I could do a lot better with some healthier choices without the temptation of substituting with a side of fries.

Although the schedule for a physician often means long hours and odd sleeping patterns, that doesn't mean that there is no time for exercise. It may be difficult, but there are choices. I often will choose to watch a one hour television program while I could be out for a nice walk or run. The truth is, everybody is busy. I have seen business executives who work 80 hours a week find time for a morning run or at least strap on the walking shoes for a quick trip at lunch. If we, as physicians, expect our patients to squeeze into a smaller waist size by squeezing in workouts and making healthy food choices, then we really need to practice what we preach. I know I am still not good at making the right choices, but I hope I can learn from my healthier classmates, mentors, and patients how to take care of myself better so I can inspire others to do the same.

The Most Therapeutic Force

Although I have thought of many of the points that Kirsner makes in this article, II know that I’ve never been able to put them so eloquently. I appreciate the honest and realistic approach that he used to examine the tough balance that exists between the art and science of medicine.

At one point he describes the relationship as “personal interaction that transcends ethnic, sociocultural, and economic differences, generating trust and responsibility.” I appreciate this definition of the patient-physician relationship immensely. There is a huge importance today in being able to relate to patients on a level that is beyond a scientific discussion of a disease. It is very important to be able to build a sense of trust and understand with a patient in order to care for them, especially in patients with chronic diseases.

It is true that the times have changed. There is emphasis on new techniques and tests and adding new technologies to the toolbox. One thing not discussed in the article that I thought of while reading was the idea of telemedicine. There was an article once that I read a couple of years ago about how a prison in Texas was using remote sites across the state. Inmates were driven to the remote site equipped with the proper testing instruments, a small lab, and a nurse. A physician located at a central site would then use video and audio to direct the nurse in her procedures. The test results would be studied and any necessary treatment was ordered by the physician and carried out by the nurse. While there is a necessity in this case with dangerous transport of the inmate and far distances to travel, there seems to be a loss of interaction. When I studied the process, I thought it might be a step medicine could take, but then I realized how poor the interaction is between the patient and doctor. I quickly decided that there needs to be human contact in order to put the patient at ease and allow the physician to gather information that can only be obtained through hands on patient interactions.

At the end of the article, I was glad that Kirsner pointed out that even though there is a need for good patient-physician interaction, all of the good intentions can’t be substituted for good skills. Physicians should be able to use the tools and knowledge they have to make timely and accurate diagnoses. This is where I know the balance will get tough. It is hard to have to know massive amounts of information and still have to focus on a quality conversation with each and every patient. The complex relationship that is formed is one that will be difficult, yet necessary if I hope to be a good physician for my future patients.

What Does it Mean to be a Physician?

This article is a great way to sum up many of the discussions that I had with fellow classmates as an undergraduate student about the way that physicians are expected to practice. Since we studied the management of healthcare and health professionals, I found myself constantly asking myself what makes a physician “good” and I could never really come up with a satisfying answer. The best conclusion I had was that I would settle for any physician who possessed the personal attributes I am looking for as long as they met the minimal knowledge and skills set forth in their profession. However, I am still torn as to whether I was faced with having to choose the top rated surgeon with a bad attitude or the lowest ranked one with the best attitude, I am still not sure what I would actually pick. This article points out that a medical education should include teaching not only knowledge and skills but also the attributes that physicians need to possess.

The three attributes of caring, inquisitiveness, and civic-mindedness are necessary personal attributes to make a physician trusted and able to practice medicine well. I don’t think it should be difficult for most of us to fill these attributes, especially as students at UMD where the focus is inclusive of academics and interpersonal skills. Our training will hopefully prepare us to be physicians in the fullest meaning of the word.

In the article, the point that stuck out the most was that we have often equated caring with treatment, which has affected patients’ attitudes about their physicians in critical times. The takeaway point from this for me is to be very aware when I am faced with a patient who is nearing the end of treatment possibilities, I will be sure to continue doing everything that I can for them. I want to create physical as well as emotional contentment, even if the patient and I both know that the outcome is not what anybody would hope for.

Knowing the focus of the UMD Medical School and reading this article have refreshed my excitement for learning everything I need to know to be the best physician I can. I want to take advantage of every opportunity to learn knowledge and skills. In addition, I also want to ensure that I learn to improve my ability to be caring, inquisitive, and civic-minded.