Physician Integrity, Templates, and the ‘F’ Word

Musher, Daniel M.; Hayward, Christiana P.; Musher, Benjamin

doi:10.1016/j.jemermed.2019.03.046

Cited by 3 publications

(4 citation statements)

References 21 publications

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“…The AP group noted "be transparent and truthful" and "be trustworthy and dependable" as crucial characteristics (Table 3). Ethics in emergency medicine related to physician integrity, templates, and the "F" word have been described for providing medical care [37]. Health professionals are expected to tell the truth.…”

Section: Discussionmentioning

confidence: 99%

Emergency Physician Professionalism: 360 - Degree Perceptions of Healthcare Providers and Patients in Thailand and USA Cultural Context

Narajeenron

Tarapan

Dukovic

et al. 2022

Preprint

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Background: We previously demonstrated generational perspectives of emergency physician professionalism (EPP) defined by healthcare providers and patients in the USA. The present study aimed to further explore EPP perceptions among healthcare providers and patients from emergency departments in the USA and Thailand. Methods: A multicenter cross-sectional study in university-based emergency departments was performed in the USA and Thailand from July 2016 to January 2017. Participants were enrolled from seven centers (USA=2, Thailand=5). All participants were pooled and categorized into two groups: healthcare providers and patients. The former group consisted of attending physicians (APs), nurses, residents, and 4th and 1st year medical students (MS4s and MS1s, respectively). Each participant independently ranked 39 cards describing qualities of EPP. Descriptive statistics, quantitative cultural consensus, and Pearson correlation coefficients were used to assess the data. Results: The total number of participants was 984, with the majority from Thailand (n = 683; 69.41%). The groups of APs, nurses, residents, MS4s, MS1s, and patients included 89, 196, 135, 197, 170, and 197 subjects, respectively. In the USA, APs had a wider range of ages (30-68) than those in Thailand (29-49). APs and nurses had more experiences of unprofessional EPP than MS4s, MS1s, and patients. Thai MS1s started medical school earlier than students in the USA. Both MS4s and MS1s in the USA had more healthcare work-related experiences. All cohorts agreed that having excellent knowledge and procedural skills is the most important behavior for EPP, while wearing a white coat is the least important. The overall data demonstrated a pattern of borderline cultural consensus regarding EPP (eigenvalue ratio = 3.07, mean competency = 0.5, and negative competency = 3.15%), with a validity of 0.95. There was no cultural consensus among healthcare providers and patients.Conclusion: This is the first study showing EPP perceptions in healthcare teams and patients from the USA and Thailand. All participants selected the same rankings of the most and least important EPP-related issues. However, no absolute cultural consensus among healthcare providers and patients was identified. Therefore, more studies on the aspects of EPP are required.

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Section: Discussionmentioning

confidence: 99%

Emergency Physician Professionalism: 360 - Degree Perceptions of Healthcare Providers and Patients in Thailand and USA Cultural Context

Narajeenron

Tarapan

Dukovic

et al. 2022

Preprint

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“…Such patterns of under-, over-and inappropriate documentation were identified amongst 96% of videotaped physical examinations in a study of medical students [36]. Clinical cultures and documentation pathways can, in some cases, induce incorrect or even fraudulent physical examination documentation [37]. By contrast, a digital image mitigates this barrier of personal examiner responsibility by facilitating easy, rapid, collegiate review [8].…”

Section: Plos Onementioning

confidence: 99%

Optimising fundoscopy practices across the medical spectrum: A focus group study

et al. 2023

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Introduction Fundoscopy can be of great clinical value, yet remains underutilised. Educational attempts to improve fundoscopy utilisation have had limited success. We aimed to explore the barriers and facilitators underlying the uptake of clinical direct ophthalmoscopy across a spectrum of medical specialties and training levels. Methods Ten focus groups were conducted with medical students (n = 42), emergency department doctors (n = 24), basic physician trainees (n = 7), hospital physicians (n = 6) and general practitioners (n = 7). Independent thematic analysis of transcripts was conducted by three investigators. A consensus thematic framework was developed, and transcripts were reanalysed using this framework. Results Thematic analysis identified seven main themes: (1) technical barriers to performing fundoscopy examinations; (2) clinical culture and expectations regarding fundoscopy; (3) the influence of fundoscopy on clinical management; (4) motivation to perform the examination; (5) novel technology including smartphone fundoscopy, and the value of a digital fundus image; (6) training requirements, and; (7) use of limited resources. Conclusion Our results build a more nuanced picture of the factors which determine fundoscopy utilisation. As current barriers limit practice by clinicians and medical students, expertise and confidence performing and interpreting fundoscopy are lost. This shifts the balance of perceived clinical utility to futility in changing patient management, and reinforces a cycle of reducing fundoscopy utilisation. We identified important cultural barriers such as accepted incompetence, and misperceptions of senior discouragement. Emerging technologies reduce the technical barriers to fundoscopy. Therefore education should: focus on detecting pathology from digital images; clarify the role of fundoscopy in patient management, and; be targeted at key career progression points.

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“…Prepopulated forms, auto-fill in options, and copy-paste mechanisms in EHRs virtually invite users to provide fraudulent and corrupted data. Strong emphasis should, therefore, be put on professional integrity in particular in case of administrative pressure, to come up with financially relevant data [39,40].…”

Section: General Ethical Discoursesmentioning

confidence: 99%

“…Ashton and Sullivan [55] Baldini et al [38] Boers et al [36] Bourla et al [45] Brill et al [49] Brisson et al [33] Carter et al [35] Davenport and Kalakota [25] De Riel et al [31] Duckett [29] Eberlin et al [52] Erikainen et al [28] Evans and Whicher [47] Galvin et al [48] Gensheimer et al [54] Gooding [46] Graham et al [26] Ho and Quick [57] Lenca et al [56] Kogetsu et al [21] Kuhnel [53] Laurie [58] Lehmann et al [23] Loftus et al [37] Macdonald et al [50] Mars et al [51] McBride et al [40] McWilliams et al [20] Meredith et al [30] Moscatelli et al [22] Musher et al [39] Natsiavas et al [43] Pathak and Chou [44] Rashidi et al [27] Robichaux et al [41] Sánchez et al [34] Sanelli-Russo et al [24] Stockdale et al [42] Wilburn [32] [56] provided an overview of ethical themes grouped as families and subfamilies. There was a preponderance of studies found on independence and safety considerations.…”

Section: Articlementioning

confidence: 99%

Clinical Information Systems – Seen through the Ethics Lens

2020

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Objective: The more people there are who use clinical information systems (CIS) beyond their traditional intramural confines, the more promising the benefits are, and the more daunting the risks will be. This review thus explores the areas of ethical debates prompted by CIS conceptualized as smart systems reaching out to patients and citizens. Furthermore, it investigates the ethical competencies and education needed to use these systems appropriately. Methods: A literature review covering ethics topics in combination with clinical and health information systems, clinical decision support, health information exchange, and various mobile devices and media was performed searching the MEDLINE database for articles from 2016 to 2019 with a focus on 2018 and 2019. A second search combined these keywords with education. Results: By far, most of the discourses were dominated by privacy, confidentiality, and informed consent issues. Intertwined with confidentiality and clear boundaries, the provider-patient relationship has gained much attention. The opacity of algorithms and the lack of explicability of the results pose a further challenge. The necessity of sociotechnical ethics education was underpinned in many studies including advocating education for providers and patients alike. However, only a few publications expanded on ethical competencies. In the publications found, empirical research designs were employed to capture the stakeholders’ attitudes, but not to evaluate specific implementations. Conclusion: Despite the broad discourses, ethical values have not yet found their firm place in empirically rigorous health technology evaluation studies. Similarly, sociotechnical ethics competencies obviously need detailed specifications. These two gaps set the stage for further research at the junction of clinical information systems and ethics.

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Physician Integrity, Templates, and the ‘F’ Word

Cited by 3 publications

References 21 publications

Emergency Physician Professionalism: 360 - Degree Perceptions of Healthcare Providers and Patients in Thailand and USA Cultural Context

Emergency Physician Professionalism: 360 - Degree Perceptions of Healthcare Providers and Patients in Thailand and USA Cultural Context

Optimising fundoscopy practices across the medical spectrum: A focus group study

Clinical Information Systems – Seen through the Ethics Lens

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