Imperfect by design: the problematic ethics of surgical training

2019 ◽  
pp. medethics-2019-105837
Author(s):  
Connor Brenna ◽  
Sunit Das
Keyword(s):  
Quality Of Care ◽  
Academic Medicine ◽  
Medical System ◽  
Teaching Hospitals ◽  
Medical Professionals ◽  
Short Term ◽  
Optimal Care ◽  
The Social ◽  
Ethical Demand

There exists in academic medicine a core ethical issue that is seldom pursued: trainees are frequently not the best person in the operating room at a given intervention being performed, and yet as a profession we understand a fundamental need to afford them opportunities to perform. Academic centres are traditionally associated with a higher quality of care than non-academic centres, suggesting that practical measures exist within teaching hospitals that effectively mask the clinical discrepancies between trainees and their preceptors. Nonetheless, we are bound by our ethical commitments as physicians to balance the obligations of care with the duty to teach. In order to ethically validate the model of ‘surgeon as teacher’, we propose that there must be a reconciliation of the tensions between traditional professional values in medicine (which tend towards individualist deontology and the provision of optimal care tailored for each patient) with the constraints inherent in a time-bound utilitarian medical system (in which resources are limited and surgeons are transient). Ultimately, we must consciously accept that ensuring the longitudinal availability of skilled surgeons in society aligns more closely with our core ethical obligations as outlined in the social contract that medical professionals maintain with the general public than does the ethical demand to provide unreservedly individual-focused patient care. It is the duty of individual practitioners, as a necessity of lineage to maintain and fulfil our greater duties to society, to foster deontological relationships where possible within this utilitarian system while accepting short-term imperfection in our practice.

Abstract 282: Assessing Levels of Active Participation through a VA Provider Network to Improve Quality of Care for Veterans with Heart Failure

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Anju Sahay ◽  
Paul Heidenreich
Keyword(s):  
Heart Failure ◽  
Quality Of Care ◽  
Active Participation ◽  
Teaching Hospitals ◽  
Evidence Based Practices ◽  
Provider Network ◽  
Participation Level ◽  
Level Data ◽  
Facility Level

Objective: The goal of the Dept. of Veterans Affairs (VA) Chronic Heart Failure (CHF) QUERI program is to improve the quality of care for heart failure (HF) patients and implement evidence-based practices throughout the VA system. One strategy to achieve this goal was to create a VA heart failure provider Network which occurred in 2006. We sought to characterize provider participation in this mature network. Method: We tracked all members of the HF Network including their title, location at one of 144 VA facilities; date joined and if applicable, date left the HF Network. We considered the following activities to be evidence of “active” participation: attended a web-based meeting or the annual in-person meeting, requested meeting materials, or completed a periodic survey of providers. Participation of all other members is considered “passive”. For this project we assessed each facility’s level of participation in the HF Network from July 2006 till June 2013 (7 years). Facility participation level was characterized as “None” (no member at that facility with active participation), “Low” (at least one member at that facility attended 1-2 activities) and “High” (at least one member at that facility participated in ≥3 activities). Data were linked to existing facility-level data that included presence of an HF clinic, cardiac cath lab, use of pharmacist, bed size, membership in Council on Teaching Hospitals (COTH), and presence of an Accredited Graduate Medical Education (ACGME) program. Results: Altogether, 1205 providers have participated in the HF Network. As of June 2013, 987 providers from 144 VA facilities participate in this network. They include VACO leadership (1%), VISN leadership (4%), facility leadership (9%), Chiefs of Cardiology (7%), staff physicians (32%), nurses (28%), pharmacists (5%) and others (14%). Participation at the facility-level has increased from 2008 (None=37, Low=43 and High=64) to 2013 (None=8, Low=16 and High=120, (p <0.001). High participating facilities were more likely to be classified as tertiary (p <.016), COTH members (p <0.001), having ACGME programs (p <0.001), and located in the West or Southeast United States (p =.03). High participating facilities are also more likely to have a HF clinic (p <0.001), a cardiac catheterization lab (<0.001), and use a pharmacist in routine HF care (p <.03). Conclusions: Involvement and active participation in the VA HF Network has grown and is more likely at academic facilities and those providing more intensive services.

TECHNOLOGY

PEDIATRICS ◽  
1978 ◽  
Vol 61 (1) ◽  
pp. 4-4
Author(s):  
Jerry Avorn ◽  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Care Delivery ◽  
Healing Process ◽  
Economic Changes ◽  
Profit Margins ◽  
Technological Imperative ◽  
The Social ◽  
Social Uses

We must not assume, as we so often have, that any problem can be solved merely by the application of more technology, and more hardware. In the case of medicine, far-reaching cultural and economic changes will have to take place before we can develop an optional health care system—changes which need have nothing whatever to do with machines or automation. A computer, or a "patient's assistant," can improve the quality of care or render it mediocre; it can be a means of freeing medical talent for larger questions, or just larger incomes; it can increase the dignity of healing or it can cheapen and degrade the experience. These are outcomes that are relatively independent of the technology itself; as we have learned so often and so painfully, it is the social uses to which we put these capabilities that are crucial. If we don't allow a blind technological imperative to squeeze all that is human out of the healing process, if we don't let lust for maximized profit margins contaminate even more of medicine, these tools may play a role in ending the crisis of health care delivery we now face. But if we choose to approach these problems as we have approached so many others in this century, even pulling out all the plugs won't help.

Telestroke and Teleneurology

2021 ◽  
pp. 95-108
Author(s):  
Hartmut Gross ◽  
Jeffrey A. Switzer
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health Care Professionals ◽  
Stroke Patients ◽  
High Quality ◽  
Optimal Care ◽  
Widespread Application ◽  
Rural Sites ◽  
Physician Liability

Evaluation and treatment of acute stroke is the oldest and most widespread application of telemedicine. Telestroke systems allow provision of the same high quality of care provided at specialized stroke centers to patients at emergency departments without stroke coverage. The early treatment achieved with telestroke leads to better functional outcomes in stroke patients, thereby lowering overall cost of patient care. Telestroke networks facilitate optimal care, decrease hospital and physician liability, educate health care professionals, and keep many patients closer to home. Admissions to, rather than transfers from, rural sites retain hospitalization revenues locally and help keep small, financially struggling hospitals viable.

scholarly journals Individual and Social Factors Affecting Nurses’ Attitudes Toward and Quality of Care Given to Patients Who Attempted Suicide

2018 ◽  
Vol 3 (2) ◽  
pp. 82
Author(s):  
Fariba Bolourchifard ◽  
Fatemeh Basaadat Kavkouhi ◽  
Ali Darvishpoor Kakhaki ◽  
Maliheh Nasiri
Keyword(s):  
Quality Of Care ◽  
Nursing Care ◽  
Significant Relationship ◽  
Work Experience ◽  
Attempted Suicide ◽  
Factors Affecting ◽  
The Social ◽  
Critical Patients ◽  
Quality Of Nursing

Introduction: Nurses are the first healthcare professionals who meet patients who attempt suicide, and their attitudes toward these patients may be important. The purpose of this study was to evaluate the effect of demographic factors on nurses’ attitudes toward patients who attempt suicide and the quality of nursing care that these patients receive.Materials and Methods: This descriptive-correlational study was performed using the convenience sampling method on 182 nurses working at selected hospitals of medical universities in Tehran, Iran. Data were collected using questionnaires that gathered information about demographics, nurses’ attitudes toward patients who attempted suicide, and the quality of nursing care provided. Data were analyzed by the Statistical Package for the Social Sciences v.20 software and by the Pearson test and t-tests.Results: Regarding social and mental aspects, we found no significant statistical relationship between age and work experience with respect to nurses’ attitudes toward and the quality of care provided to patients who attempted suicide, but women provided higher-quality nursing care than men (P=0.046). Although the relationship between education and quality of nursing care was statistically significant (P=0.007), we found no significant relationship between education and attitude.Conclusion: We found no significant relationship between age and work experience with respect to nurses’ attitudes toward, and the quality of care provided to, patients who attempted suicide, but women provided higher-quality nursing care than men. Furthermore, quality of care was higher from nurses who had a bachelor-level education, suggesting that higher-educated nurses should be recruited to care for critical patients.

scholarly journals The Experience of Care Partners of Patients with Parkinsonism and Psychosis

2021 ◽  
Author(s):  
Sneha Mantri ◽  
Emily Klawson ◽  
Steven Albert ◽  
Robyn Rapoport ◽  
Chelle Precht ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lived Experiences ◽  
Emotional Reactions ◽  
Medical System ◽  
Medical Professionals ◽  
Telephone Interviews ◽  
Experience Of Care ◽  
Sources Of Knowledge ◽  
Care Partners

ABSTRACTBackgroundParkinson’s disease psychosis (PDP) has a major impact on quality of life and care partner burden; however, little is known about the lived experiences of care partners in managing PDP.ObjectiveTo understand how care partners of individuals with PDP experience their role and articulate their needs related to psychosis.MethodsThis was a qualitative study of semi-structured telephone interviews. Recruitment was conducted online via the clinical study matching tool, Fox Trial Finder; study activities took place remotely via telephone interviews. Transcripts of the phone interviews were analyzed by grounded theory methods, and a codebook of key themes that emerged from the analysis was developed.ResultsNine care partners (all female) were interviewed. Discussion topics in the codebook included (1) care partner burden and guilt; (2) communication with medical professionals; (3) coping strategies; (4) emotional reactions of the care partner to psychosis; (5) sources of knowledge about PD psychosis; (6) attitudes towards medications for PDP; (7) strategies to care for loved ones with psychosis; (8) psychosis triggers.ConclusionsThis qualitative analysis uncovers important aspects of the care partner experience, including challenges in navigating the medical system and communicating with professionals. Providers treating patients with PDP should be aware of these constraints and provide added support for strained care partners.

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