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Ethics 101
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Scenario Archives
A Colleague in Trouble
You are a physician who works in both urban and rural settings. Over the past six months, the behavior of a
colleague you have known for 10 years has changed. The physician has:
become somewhat unreliable, showing up late for meetings and/or procedures undergone personality
changes
lacked attention to detail
occasionally smelled of alcohol
lacked judgment in some situations
responded negatively to colleagues who have attempted to intervene
What would you do in this situation?
Responses, as published in the Messenger, to this issue:
I would first discuss with another colleague my observations and conclusions. Hopefully we would then go
together to address her/him in a friendly, candid manner if we judged we had a reasonable chance of her/his
seeking appropriate help. (Dr. C liff Nelson)
This situation should be handled in the same way as any person employed in a position which would be
considered a critical safety positionSince this is a physician governed by the rules of a governing board, the
C ollege should be notified. It would not be your role to treat or diagnose this situation. (Dr. Tim Lepard)
The first step when encountering a case like the one described, is the recognition that there exists a great
likelihood of problematic substance use, which may not be limited only to alcohol. Untreated substance use
disorders in healthcare professionals may have the potential of placing the public at risk, and where a
reasonable index of suspicion exists, notification of the local regulatory body is indicated. This activates a
protocol for full assessment, and if indicated, the appropriate treatment.Exciting new treatment options are
emerging for the treatment of addiction and comorbid mental health concerns, and the occupational, health, and
social outcomes for impaired physicians are indeed optimistic.The biggest dilemma physicians face is realizing
that reporting of an impaired colleague is in the best interest of the involved physician and his patients, and in
dispelling the perceived notion that staying silent protects our colleague. Silence only maintains the disease.
(Dr. C harl Els)
You are a family physician with hospital privileges working in a large urban clinic. Following hospitalization for
Were
you able to
findofthe
information
pneumonia,
one
your
long-termyou
patients gives you a gift as a thank you for the care you provided. The gift is
were
looking for?
a $250.00
certificate
to a *well-known local tailor who you know does excellent work. What would you do in this
situation?
Responses, as published in the Messenger, to this issue:
The physician-patient relationship is complex and matures with time. It is the responsibility of the physician in
this situation, therefore, to gauge the maturing and appropriateness of the physician- patient relationship, and to
determine the appropriateness of accepting the gift. This is one aspect of our professionalism that will not be
able to be subjected to any blanket rule. (Dr. J. Fernandes)
It is never appropriate to accept monetary gifts or gifts of significant monetary value from patientsI believe
that personal gifts or tokens of appreciation, such as Thank you cards or handmade gifts having more
sentimental than monetary value, are entirely appropriate, and in fact are a healthy form of interaction between
care providers and patients...Fundamentally, the issue devolves to this. It is a reasonable expectation that
treating physicians accept and recognize the sentiment of gifts from patients. In order to retain an appropriate
and healthy relationship with ones patients, gifts which benefit the physician financially must always be
redirected or refused. Like any other interaction with a patient, documentation is necessary. (Dr. M. Rose)
I recommend not accepting the gift because this could have problems down the road. (Dr. H. Hoffman)
http://www.cpsa.ab.ca/resources/ethics_101/Ethics_101_Archives.aspx
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Disparaging Comments
You are the training director for a residency program. Recently, several residents have come to you reporting that
a physician frequently makes disparaging comments to residents and to patients about the work of other
physicians.
The physicians latest comment was to a patient in which he said he would not allow a particular physician to treat
his pets.
Other comments attributed to this physician involved telling the residents that a surgeon is a butcher and a
psychiatrist a mindless twit.
The residents have attempted to speak to him about this practice to which the physician responded by saying he
only speaks the truth, adding that patients and residents have a right to know.
The residents report the comments appear to be unwarranted and they seem to be scaring the patients. Is this
physician behaving unethically? Should physicians question the work of their colleagues? How should this be done?
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The physicians primary responsibility is the patients well being. Any concern about the maligning of the physicians
reputation by the specialist is secondary.
In this case, the specialist caused direct and willful harm to the relationship between the physician and her patient.
This is a complex longitudinal relationship that is built on mutual trust and respect and is central to the patients
care over the long term.
The criticism of one physician by another is often, as in this case, fueled by lack of information and understanding
and is often unprofessional. There are venues to report truly incompetent care.
If the specialist presumed the right to criticize the physician, then the specialist also had an obligation to ensure
that his/her information was both correct and complete before rendering an opinion to the patient.
In this case, the specialist did not attend to his/her responsibility to ensure that he/she had complete and correct
information prior to rendering an opinion to the patient about the incompetence of the physician.(...) see full text
(Dr. John Fernandes, C algary)
I read the Ethics 101 article in the latest issue of the "Messenger". I realize that you are expecting opinions from
within the profession but I think that as a lay person I might have something to contribute. The danger of a well
known physician having undue pressure on his/her colleagues would indicate that perhaps inviting these doctors to
present at seminars supported by a pharmaceutical company would be contraindicated in a self governing
profession that prides itself on it high standard of ethics and morality. These ethics must not only be practised but
they should be seen to be practised. A physician who had been heavily involved in clinical studies and who was
going to give an objective report on those studies, carefully avoiding any temptation to encourage the use of the
treatment by others is probably an acceptable case.
I have done some research and I would like to submit some numbers which might represent the cost to the
company and benefit to the physician. I assume that the company wants to make a good impression on the
physician, the amount of the honorarium is a guess as are allowances for meals and incidental expenses.
Item
How Calculated
Total
airline website
$7,176
4 nights @ $935
$3,740
Meals
4 days @ $200
$800
estimate
$500
Honorarium
estimate
$5,000
Grand Total
$17,216
I have been the patient of an incredible physician for almost 27 years and from what I understand if I were to give
her a cheque for this amount she would have to answer to the college for receiving a large gift from a patient, I
have read of such cases in the "Messenger". What is the difference from an ethical point of view if the gift comes
from a patient or a pharmaceutical company? If I have overestimated the amounts of money I would appreciate a
correction. (Paul S. Hinman, Edmonton)
http://www.cpsa.ab.ca/resources/ethics_101/Ethics_101_Archives.aspx
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Remaining Silent
You have been reading a lot about the patient safety movement and the disclosure of errors to patients and their
families. You cannot stop thinking about the following incident that occurred while you were a resident.
While on call you were asked to see a woman whose labour was being induced with oxytocin or syntocinin. The
fetal pH was becoming unacceptable and after consultation with your attending physician you elected to proceed
http://www.cpsa.ab.ca/resources/ethics_101/Ethics_101_Archives.aspx
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http://www.cpsa.ab.ca/resources/ethics_101/Ethics_101_Archives.aspx
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End-of-life care
Dr. Jones is an internist working in a tertiary care hospital. She covers the general medical units on weekends and
supervises residents. Last weekend, a resident came to her with concerns about a patient who was receiving end of
life care.
The patients family had been reading about the Quebec discussion on euthanasia and expressed fears that the
pain relief being offered to their mother was designed to hasten her death. They were very opposed to this and
wanted the resident to reduce the amount of medication given.
The patient is unable to participate in these discussions and the resident is concerned that the patient will suffer
extreme pain if the dose is lowered.
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