Academic housestaff and faculty have frequent PR contact; such contact is related to changes in behavior. The potential for influence of PRs in academic medical centers should be recognized, and their activities should be evaluated accordingly.

A clinical ethics consultant gathers information firsthand at the patient's bedside. The consultant's special clinical skills include the ability to identify and analyze ethical problems; use reasonable clinical judgment; communicate effectively; negotiate and facilitate negotiations; and teach others how to construct their own ethical frameworks for medical decision making. Appropriate roles for the consultant include those of professional colleague, negotiator, patient and physician advocate, case manager, and educator. The training necessary for an ethics consultant includes substantial patient care experience, instruction in health care law and moral reasoning, and preparation in medical humanism. We favor a clinical model for ethics consultation. When urgent care is needed, other consultants promptly see the patient; the clinical ethics consultant can be expected to do the same.

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Students increase their understanding of the humanities through readings, small group discussions, journal keeping and formal writing. By incorporating humanism into their professional lives, medical students can learn to care for their patients in a more humane and thoughtful manner.