Presentation on theme: "Residents: Healers in the making"— Presentation transcript:
1 Residents: Healers in the making Thalia Arawi, PhDClinical BioethicistDirector, Salim El-Hoss Bioethics & Professionalism ProgramVice-Chair, Medical Center Ethics CommitteeFaculty of Medicine
2 Welcome! Welcome to Residency! Being part of this profession entails ethical and professional obligations (Dr. Zeineldine addressed you on this)In part, this requires learning to “think ethically” through self-reflection, alone and with othersAt AUBMC we are committed to Patient Centered Care.Any resident and attending who fails to do that fails in professionalism and betrays his/her profession.
3 PlanFew words about what patients think of physicians. Food for thoughtMCEC: Bioethics in direct relation to Patient CareFinal words
4 A study assessing the public perception regarding physicians in Lebanon revealed the following: The physician traits most desired by the public were found to be: moral traits (41%), interpersonal traits (36%), scientific traits (19%) and other (4%).The most unwanted traits/behaviours were a lack of interpersonal traits (57%), a lack of moral traits (40%) and a lack of scientific skills (3%).
5 Sample Traits Not Desired Desired Inhumane Negligent Does not admit mistakesDishonestHurriedDoes not discuss with patientsUnfriendlyTreats patients as a number or caseDisrespectfulArrogant:Does not respect appointmentsHigh-handedTreat patients as inferiorPretentiousAnnoyed with questionsDoes not listen to patientsHumaneHonestEthicalNot materialisticCompassionateHumbleGod fearingExplains thoroughlyGood listenerRespects patientsHas good interpersonal skillsGives time to patientsCaringPatientSmilesIs not haughtyNot DesiredDesired
6 We all need to start thinking… Regression in moral development and empathy in residents as they progress through medical school is RAMPANT.You can guard against it by emulating good role models and self-reflection.How not to fall prey to the dehumanization of medicine?Invasion of Money into MedicinePhysicians became the service providersPatients became “clients”Doctors can now make a lot of money (regardless of how)The profession began attracting the “wrong” kind of personThe Hidden Curriculum: everything matters (how you dress, talk, communicate, examine, treat, etc.)
7 "As I look into the future, I think we will undoubtedly be a much more divided profession than we are now. We will not have again an ethic which will bind all of us," There will be "those who choose to follow the moral imperative--the high ground--and those who become purely businessmen and entrepreneurs."It is YOUR CALL!E. D. Pellegrino, Previous Chairman of the President's Council on Bioethics
8 Being a “good physician” Healthcare Practitioner (ST) or Healer?YOUR CHOICEIs much more than following rules and principlesIt is about what kind of person you are and want to becomeRules and Principles taughtBecoming process (will, mind, heart)Doing the right thing when NO ONE IS LOOKING!
9 SHBPP-AUBFM HUMANISM AND PROFESIONALISM AWARD, 2012 Dr. Darwish
10 SHBPP-AUBFM HUMANISM AND PROFESIONALISM AWARD, 2013 Dr. Costa
17 What is a Clinical Ethics Committee? Final treatment decisions are made between the attending physician and patient or surrogate-decision maker.Group of professionals who meet to consider and discuss the ethical aspects of clinical care within the hospital.It gives opinions or recommendations.
18 Education Policy Functions of the MCEC Case Consultation facilitates educational opportunities for health care professionals, patients, and their families.provides consultative services regarding ethical issues pertaining to a specific patient.discussions and evaluations of policies and procedures having ethical implications.MCECCase ConsultationPolicyCase Consultation
19 Members represent Diverse medical depts. Other departments (such as nursing, social services)Religious viewsHospital administrationLawyerBioethicistCommunityMembers bring experience and expertise from their areas.
20 Common Ethical Issues Withholding or withdrawing treatment Do Not Attempt Resuscitation orders (DNR/AND)Identification of patient’s representativeMedical futilityInformed consentAborting a fetus with malformationDetermining decision-making capacityPalliative care issuesConflict resolutionPerinatal & neonatal issuesOther
21 The “Ashley Treatment”.. 5’The “Ashley Treatment”..Ethics Committee recommended the Ashely Treatment
22 Born 1997 with static encephalopathy (permanent brain damage) of unknown etiology Breathes on her own but unable to raise head up, sit up, hold and object, walk, talk, must be tube fed2003 Signs of puberty2004 received “Ashley Treatment”High doses of estrogen to halt growthHysterectomy Breast bud removal
24 Was this right? At least two points: Ethics is part and parcel of patient care (medicine)Discussion and decisions cannot be made at a distanceWho should decide?Who should be involved when making the decisions?The fact is that the decision created a great deal of controversy.But it was done in good faith.
25 The average hospital ethics committee receives 3 requests for case consultation per year
26 AUBMC Medical Center Ethics Committee (MCEC) From 2005 to March 2012, only 5 cases were referred to the medical center Ethics committee for recommendation.
30 Our Lives are Dedicated to Yours! Loaded term… we are responsible/accountable for it
31 A note.. The elderlyOften older people are treated with less enthusiasm, care and dedication“They are old”What you owe to the child, the adult, you owe to them, even more.
32 Good Luck in entering yet another learning phase.. As physicians Remember:Do not judge others from your own perspective. Keep an open mind, develop a bird’s eye view of things. You will be surprised what you will discover.You are now residents. Med students are not your subordinates. They are what you have been just a few days ago and they are the future you. Be kind to them and help them learn as you learn. Be a role model.Medicine is about team work. Nurses, Physiotherapists, etc. are educated healthcare professionals and members of the healthcare team. Without them, there is no patient centered care.The patient is your “partner”, your “teacher”, not your “tool”.
33 RESPICE FINEM, for you too are mortal. The patient “has” a disease, he/she “is” not a disease.The patient has a name like yours, which is not a room number nor ends with something like “-itis”.Residents and physicians often suffer from a chronic iatrogenic disease called Egotitis. The only proven remedy to this illness is humility and remembering your own finitude and mortality.The reputation of a lifetime may be determined by the conduct of a single moment.RESPICE FINEM, for you too are mortal.