Supplements

Professionalism and medical ethics

Copyright © 2006 Society of Hospital Medicine

Professionalism refers to guidelines and attributes that require the physician to serve the interests of the patient above his or her self‐interest. At the individual practitioner level, this denotes a commitment to the highest standards of excellence in the practice of medicine and in the generation and dissemination of knowledge to sustain the interests and welfare of patients. Within the practice of hospital medicine, professionalism also includes a commitment to be responsive to the health needs of society and a commitment to ethical principles. Hospitalists frequently encounter ethical dilemmas in their daily practice because issues arise regarding end of life care, the ability of the patient to consent to treatment, and pressures of resource utilization. Hospitalists lead, coordinate and participate in systems improvements that promote professionalism in health care delivery.

KNOWLEDGE

Hospitalists should be able to:

  • Define and differentiate ethical principles, which may include beneficence and nonmaleficence, justice, patient autonomy, truth‐telling, informed consent, and confidentiality.

  • Describe the concept of double effect.

  • Define and differentiate competency and decision making capacity.

  • Explain the utility of power of attorney and advance directives in medical care.

  • List the key elements of informed consent.

  • Explain determination of decision making capacity and steps required for surrogate decision making.

  • Describe local laws and regulations relevant to the practice of hospital medicine.

  • Explain medical futility.

SKILLS

Hospitalists should be able to:

  • Observe doctor‐patient confidentiality and identify family members or surrogates to whom information can be released.

  • Communicate with patient and family members on a regular basis.

  • Recommend treatment options that optimize patient care, include consideration of resource utilization, and are formulated without regard to financial incentives or other conflicts of interest.

  • Evaluate patients for medical decision making capacity.

  • Obtain informed consent when indicated.

  • Review power of attorney and advanced directives with patients and family members.

  • Provide compassionate and relevant end of life care.

  • Apply ethical principles to inpatient care.

  • Follow patient's wishes as described by the patient, as outlined in advanced directives, or as described by the patient's surrogate decision maker.

ATTITUDES

Hospitalists should be able to:

  • Commit to life‐long self learning, maintenance of skills, and clinical excellence.

  • Promote access to medical care for the community.

  • Recognize when consultation from others who have expertise in psychiatry and ethics will promote optimal care for patients and help resolve ethical dilemmas.

  • Provide compassionate and relevant care for patients, including those whose beliefs diverge from those of the treating physician or from accepted medical advice.

  • Remain sensitive to differences in patients' gender, age, race, culture, religion, and sexual orientation.

  • Appreciate that informed adults with decision making capacity may refuse recommended medical treatment.

  • Appreciate that physicians are not required to provide care that is medically futile.

  • Demonstrate empathy for hospitalized patients.

  • Endorse that physicians have an obligation not to discriminate against any patient or group of patients.

  • Observe the boundaries of the physician‐patient relationship.

  • Promote cost effective care.

  • Recognize the obligation to report fraud, professional misconduct, impairment, incompetence or abandonment of patients.

  • Recognize potential conflicts of interest in accepting gifts and/or travel from commercial sources.

  • Recognize potential individual and institutional conflicts of interest with incentive‐based contractual agreements with pharmaceutical companies and other funding agents.

  • Follow a systematic approach to risks, benefits and conflicts of interest in human subject research.

  • Serve as a role model for professional and ethical conduct to house staff, medical students and other members of the interdisciplinary team.

   Comments ()