Ethics in Truth

In a case study of the Paradise Hill Medical Center, where 22 oncology patients received excess radiation treatment, the board, CEO, physicians, and management had to discuss whether to inform those patients of the error or not. Without even going into detail about the discussion, my only thought while reading this chapter was of course you have to tell them, because it’s the right thing to do!

The physicians’ first argument was that these cancer patients did not want or need any more bad news. They also said “Informing the patients of this error will only confuse them and destroy their faith and trust in their physicians and in the hospital. Yet they also agreed that they did not know what kind of effects would come from the excessive radiation. In my mind, how does anyone have the right to assume they know how a patient will react or what they will think from the news they are given, especially when the hospital does not even know whether negative results will occur from the excessive radiation or not? Every patient should be given the right whether to trust their physician and hospital or not and should be fully informed while making that decision. No patient should be deceived into trusting anyone, especially someone in charge of their health. Maybe this specific hospital has had a string of errors or has been found negligent in similar instances. These patients should be able to decide whether to continue with them or not based on all of the information.

In another argument, by the chairman of radiology, was that informing the patients would just be asking for malpractice litigation. But to counter this, in a recent article in the Annals of Internal Medicine, they cite a study who found that of 127 families who sued their healthcare providers after perinatal injuries, 42% were motivated by suspension of a cover-up or revenge. With the amount of healthcare member of the hospital that may come into contact with any of the patients who received the excessive radiation, deciding to keep this information a secret from them may become more likely to receive malpractice litigation then an honest truthful mistake that has been communicated to the patient.

In conclusion, I think the act of keeping the error information from the patients who received the error is a hospital that is only trying to look out for itself, which is extremely unethical in a field built so much on trust between physicians and patients. Not only do I think hiding the truth is unethical but I don’t think it will benefit anyone in the long run.

Physician Impairment

Physician Impairment occurring in the healthcare system is a very serious issue that has been taking place for a while. Estimates suggest that approximately 15% of physicians will be impaired at some point in their careers, and the two ethical issues that take place are the physicians involved as well as the coworkers who need to report those physicians. Just like the University Hospital Level 1 Trauma Center case in the reading, we see an example where the Jan Adams, the shift supervisor, and Dr. Truman, the resident, were worried about causing, Trauma Surgeon, Dr. Spalding any problems for not reporting to the hospital in a reasonable time. Jan refused her option to call in the second on call surgeon and decided not to in order to keep Dr. Spalding’s from receiving any kind of punishment. The let her relationship with him cloud her judgment and could have negatively affected Jan, Dr. Spalding, Dr. Truman, University Hospital, and most important, the patient. If anything at all happened to the patient everyone involved with the incident would be held responsible. Jan was risking all of their jobs, the hospital’s credibility and reputation, and the patient’s livelihood.
In this incident, Jan should have immediately called the second on call surgeon when Dr. Spalding had not arrived in a timely manner. Upon his arrival, and when she noticed Spalding’s impairment, Jan, being the shift supervisor should have reported the incident immediately. No one should put that much on the line just to keep a coworker or friend from being punished.  In a study of 100 alcoholic U.S. doctors followed for 21 years, 73% had recovered. This study and others show a strong relationship between recovery and attending meetings of self-help groups. It appears from his history Dr. Spalding needs help in the matter and should be provided by from the hospital.

Gender Discrimination and Harassment

Sexual and gender based harassment in the workplace is something that both men and women experience quite often and has become a major issue in healthcare. In a large national study done by Internal Medicine Journal, 47.7 percent of all women physicians reported having experienced gender-based harassment, and 36.9 percent reported sexual harassment. Many wonder what may be the cause of the high numbers in the health field, whether be because the high intense, personal nature of the work, working so closely together, or working long hours together.  A very valid point that I read about was because of the slowly decreasing but still high discrimination on women when hiring physicians, residents, and medical students. "The health care profession, to this date, is essentially sex-segregated, as 84 percent of physicians are male and 97 percent of nurses are female" states the "Empowering Women in Medicine" report by the Feminist Majority Foundation and New Media Publishing. While those numbers are astonishing, I believe we will be seeing a slow change into a more equal ratio. Studies consistently show that exposure to severe harassment has a direct impact on victims' emotional well-being and career satisfaction. One study concluded that "Women physicians generally report career satisfaction, but many, if given the choice, would not become a physician again or would choose a different specialty. Correctable factors such as work stress, harassment, and poor control over work environment should be addressed to improve the recruitment and retention of women physicians." (Frank, Murray, Linzer and Elon, "Results from the Women Physicians' Health Study", Internal Medicine, 1999; 159: 1417-1426).

It is quite likely that the high levels of reported sexual and gender based harassment of female medical students, residents, and physicians is related to the sudden presence of women in a traditionally white male dominated establishment. The American Medical Association has stated that, "Physician leaders in medical schools and other medical institutions should take immediate steps to increase the number of women in leadership positions as such positions become open." While I agree with fixing sexual and gender based harassment within the healthcare system, I do not think it is quite as easy of a solution as the American Medical Association suggests. You should never hire into any position for any case other that because that person is the most qualified and the best one for the job. While I do think the both harassment forms need to be resolved immediately, I think looking specifically for a woman to fill a position can only cause resentment within. I think there are plenty of highly qualified men and women out there and I think the best one should get the job. If we push for this “women only until equal” we are only creating another gender bias.

Overall, my assessment is that both men women should be created equal no matter what, and sexual harassment should be taken more seriously within the workplace. Managers and supervisors should take more responsibility when dealing with each individual case of harassment when it takes place.

Corruption through Management and Board

In Chapter 2 of our reading this week, we read a case about Qual Plus HMO and the unethical practices of both the Board Committee and the CEO. In the case Jim, the man who felt unethical practices were taking place, could not find any assistance in fighting this injustice. Corruption was already set in place when the CEO began receiving improper benefits from the board of directors creating an inappropriate relationship amongst the two. After being turned down by the CEO for advice on stopping the unethical decisions he turned to the ethics committee and was turned down again. Jim, being a member of the board, was being placed in a position where he was to either choose to go against his morals and side with the other board members or leave his position. The major question for him is that if he was to just keep quite as expected what other unethical decision would he be asked to be a part of, would they become illegal?

At that point in their organization the corruption has grown so deep, that the chances of getting back to normal are slim. Once the CEO is corrupt and he has a fully corrupt board, creating a break in the cycle would be nearly impossible, especially by one single individual. To avoid this sort of behavior I believe there should be standards set in place where CEOs and board members should be unable to give or receive gifts. By stopping this, board members would be unable to “buy” their ways onto the board, and in turn the board would be more willing to keep their CEO in check.

Honesty with Medical Errors

In the case of the Paradise Hill Medical Center, where 22 oncology patients received excess radiation treatment, the board, CEO, physicians, and management had to discuss whether to inform those patients of the error or not. Without even going into detail about the discussion, my only thought while reading this chapter was of course you have to tell them, because it’s the right thing to do!

The physicians’ first argument was that these cancer patients did not want or need any more bad news. They also said “Informing the patients of this error will only confuse them and destroy their faith and trust in their physicians and in the hospital. Yet they also agreed that they did not know what kind of effects would come from the excessive radiation. In my mind, how does anyone have the right to assume they know how a patient will react or what they will think from the news they are given, especially when the hospital does not even know whether negative results will occur from the excessive radiation or not? Every patient should be given the right whether to trust their physician and hospital or not and should be fully informed while making that decision. No patient should be deceived into trusting anyone, especially someone in charge of their health. Maybe this specific hospital has had a string of errors or has been found negligent in similar instances. These patients should be able to decide whether to continue with them or not based on all of the information.

In another argument, by the chairman of radiology, was that informing the patients would just be asking for malpractice litigation. But to counter this, in a recent article in the Annals of Internal Medicine, they cite a study who found that of 127 families who sued their healthcare providers after perinatal injuries, 42% were motivated by suspension of a cover-up or revenge. With the amount of healthcare member of the hospital that may come into contact with any of the patients who received the excessive radiation, deciding to keep this information a secret from them may become more likely to receive malpractice litigation then an honest truthful mistake that has been communicated to the patient.

In conclusion, I think the act of keeping the error information from the patients who received the error is a hospital that is only trying to look out for itself, which is extremely unethical in a field built so much on trust between physicians and patients. Not only do I think hiding the truth is unethical but I don’t think it will benefit anyone in the long run.