martes, 1 de enero de 2013

Should You Warn Patients About Substandar​d Colleagues​?


Have you ever been caught between loyalty to another physician whose skills you don't respect, and wanting to warn a patient if you knew they were scheduled to have a procedure performed by that physician?
More than 24,000 physicians answered this question in Medscape's 2012 Top Ethical Dilemmas Survey Report. Some felt that it just wasn't their business to tell a patient. "I wouldn't destroy a patient-doctor relationship by interjecting myself," said one reader.
Others said it was their duty to make sure that patients are protected from potential harm at the hands of substandard colleagues. "The phrase 'do no harm' includes protecting patients from harm," one respondent said. In addition, substandard physicians harm not only patients but also the entire medical profession, as one reader pointed out. "We must stop protecting our less proficient colleagues, since they're the ones driving up our malpractice costs."
Close to one half of the respondents (47%) said that they would inform the patient, but 16% said "no," and 37% said "it depends."
"I think it very much depends on the situation," confirms Kenneth Prager, MD, Professor of Clinical Medicine and Director of Clinical Ethics, Columbia University Medical Center, New York, New York. "The question is nuanced and complicated, with a spectrum of scenarios that are highly individual."
Even respondents who felt strongly about informing the patients commented that the particular circumstances would influence their action. In the words of one respondent, "This is very touchy!"

How Close Are You to the Patient?

Many respondents said that they would inform only if it were their own patient, family member, or friend. "If you have no relationship with the patient, then keep your opinions to yourself," one reader advised.
Others felt that the nature of the relationship was less important than the personality of the patient. "It depends on how receptive the patient would be to my input," a respondent wrote. Another quipped, "It depends on the patients' reputation for bringing lawsuits." And some thought the nature of the patient's relationship with the other physician played a role in the decision. "How invested are they in the other doctor?" one respondent queried. "Are they a regular patient, or is this a one-time procedure?"
A large number of respondents felt that the only important issue is whether the patient has asked for an opinion about the other physician. "I'd inform the patient only if the patient initiated the question," one reader said. Another added, "I wouldn't hunt down every patient on the other physician's schedule to issue a warning."
Several respondents felt that the seriousness and the complexity of the procedure make a difference. "I'd be less worried about a cholecystectomy than I would about major cancer surgery," one wrote.


No hay comentarios:

Publicar un comentario