Ethics in healthcare

Advocating for healthcare staff

Healthcare members have begun protesting the lack of Personal Protective Equipment (PPE) which is normally required for working with highly contagious diseases. Lack of PPE has resulted in healthcare workers contracting Covid-19 and some dying from the virus. Medscape has begun a list of healthcare worker deaths online.

Lack of leadership from the government has directly caused workers to be unprotected in the workplace. Other country’s leaders immediately took control of their situation on a national level, with national quarantines, providing PPE for all necessary workers, securing supplies, and testing.

Hospital’s are also responsible for a lack of leadership. Some hospitals are requiring workers to go into highly contagious work environments without PPE, leaving them with no alternative, but to quit. It is time to eliminate the administrators, who implement institutional policy regardless of the cost to front-line workers. When insubordination is brought up with employees, what it usually translates into, is a lack of leadership at the institution. Workers are being called insubordinate, sent home and some fired for wanting to protect themselves from a highly contagious and deadly disease.

Healthcare workers must continue to strike until the system changes. They must disrupt the monetary system, which rules our healthcare. It is time to shift from a for-profit healthcare system to a national healthcare system, which focuses on the health of the country. People over profit.

Doctors must discuss ventilator shortages before shortages occur

According to Politico, Italian physicians began making life and death decisions on which patients to use scarce resources on, basically who would be put on ventilators. In order for healthcare providers in the U.S. to prepare for life or death decisions, these discussions must take place before the doctors have to begin making these decisions. Ethics committees should meet, if possible, and set the standards for the healthcare team in advance. This allows doctors who are making these decisions to begin to mentally prepare for this strenuous task.

Doctors should not be afraid to talk to administrators about this topic. Dr. Deborah Birx, the White House Coronavirus Response Coordinator, said during a press conference that there is no situation right now that warrants that kind of discussion. We must not allow the government to stop needed discourse on possible worse case scenarios, especially since many people in administration are not on the front lines and do not understand the situation on the ground. Crisis of Care Standards for Covid19 have been developed by the CDC for reference, but each hospital must review them to ensure it will be possible to implement them in their situation.

Fear of speaking up, fear of retribution may have psychological impacts on healthcare professionals, who may already be at risk for PTSD from this pandemic.

Dr. Li Wenliang, 34, was the first doctor in China to raise the alarm about COVID-19. He was forced to retract the information by the Chinese government, who accused him of making false statements. He later died of the disease. In America, healthcare providers are being threatened by hospitals not to talk to the press about working conditions and some have been fired for speaking out. Healthcare workers must be able to speak. Communication is imperative and all information must be shared in order to change and improve these situations. If no one knows that there is a problem, nothing will be done to fix it. We must speak up. It can no longer be business as usual.

Screening for soft drink consumption during check-ups

In 2017, the American Heart Association, Journal of Stroke published the Framingham Heart Study which concluded that diet soft drinks were linked to cardiometabolic risk factors, which increase the risk of cerebrovascular disease and dementia. How has this information been applied in practice? We still see the majority of healthcare facilities selling diet soft drinks in their cafeterias and vending machines because of income from the soft drink companies. It is not socially acceptable to sell cigarettes or vapes in hospital gift shops, so when will society catch up with the research? Can healthcare providers lead the way in changing this unhealthy health behavior? Who will lead hospital administers to choose health over budget? At minimum, screening for soft drink consumption should be added to intake forms for PCP’s and cardiologists. Do not underestimate the power that physicians have over their patients behavior. Remember cigarette companies used to use physicians to promote their products.

Second thoughts on offer

What to do if you agreed to sign a pre-match residency contract with a program, but are having second thoughts.

This needs to be approached with much consideration and thought. The program director and staff have invested time and resources in your application and interview, and will definitely be surprised by your change of mind in signing the contract. You need to realize that this decision not to sign, after you have agreed to, may have long term effects on your reputation; however signing a three to four year contract when you have serious doubts may not be in your best interest either.

If you feel comfortable speaking to any of the residents working at the program, you might consider asking them to answer some of your questions first and see if it settles your concerns. If not then, as an adult, you need to face the issue head on.

Sit down with the program director and have an honest conversation about your questions and concerns and see if the two of you can come to an agreement on what is best for both you and the program. Program directors do not want a resident who does not want to be there and they don’t want someone to leave mid-residency. You don’t want to be somewhere that you are miserable and wishing you made a different career decision.

Writing your own LOR

What to do when a ERAS letter writer asks you to write your own letter of recommendation.

When someone asks you to do something that sounds wrong, go with your gut and decline. Your biological response of your stomach getting upset when you feel a conflict is a real response of your body saying, “This is a problem”. If you are asking someone for a favor, you may feel nervous and not want to upset them, but these small decisions add up and become the core of who you are.

Determine the best way to decline the offer in a way that allows the other person to walk away not feeling judged. Give the person an out. You could say, “I can ask someone else, I know you are very busy right now.” And thank them for considering writing a letter for you. You can also just tell them that you don’t feel comfortable writing your own letter of recommendation.

When does crossing the line matter? When does a little lie or fib become an issue of ethics. It can be hard to operate in the grey area. One way to answer the question of ethics is to ask, if faculty, employers, or residents found out about your behavior, what would the consequenses be? More importantly, would they trust your work in the future? Would your medical judgement be questioned? What about your research?

How does your reputation recover from this type of activity? Would you be considered a potential leader or someone who will do whatever it takes to promote yourself.

Being ethical matters. It is something that employees, healthcare professionals and patients desire in a person. Ethics is personal. It is something that each person has to decide to pursue on their own. The question is, do you have the guts to stand up and be uncomfortable by saying, “No thank you.” When someone offers you a shortcut.

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