Ethical Question...

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jdfamily

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I am preparing for interviews and came upon a question which I had difficulty in responding.

What would you do if you smelled a strong scent of alcohol on a surgeon who was taking over your patient?

This question applies to any scenario where you are working in a health care setting and suspect that a physician is under the influence.

I have my thoughts on it. I know we can't be prepared for every ethical question, but I do feel that this is one that really could happen to many of us as physicians.
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Tell him to go home and sober up.



(And you might want to add a good kick between the legs to get the message across.)
 
jdfamily said:
I am preparing for interviews and came upon a question which I had difficulty in responding.

What would you do if you smelled a strong scent of alcohol on a surgeon who was taking over your patient?

This question applies to any scenario where you are working in a health care setting and suspect that a physician is under the influence.

I have my thoughts on it. I know we can't be prepared for every ethical question, but I do feel that this is one that really could happen to many of us as physicians.
Click to expand...

Query privy as to the origin of the scent.
 
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Well for one, stop any procedure/ surgery that's going on; compromising patient safety is unacceptable in any medical practice. Patient safety shouldn't be anything less than priority number 1 I'd think.

Next I would say send the Physician home to sober up- not only would having an intoxicated physician at work make him/her look irresponsible, but it could also lead patients to believe that the regulation over medical care in the medical facility is substandard.

Lastly, I would say that you'd have to report that to any supervisor or medical board (or whatever governing body that you'd report that to.. I'm not really sure..), no matter how much you liked that particular physician; it would be the responsible thing to do, and would hopefully prevent any such instance from happening again!
 
Aren't you assuming that the physician is intoxicated? Just because you can smell alcohol in their breath doesn't mean they are intoxicated... same goes for when you are suspicious they are on drugs. This is where the question gets more complex for me. It's not like we can ask the doctor to take a breathalyzer test before operating to make sure he passes.

Thanks for the input!
 
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Well I guess that's true. That does make it more complex, but all in all, as a patient, I don't think that I would want a surgeon to have been drinking at all before any surgery- especially since surgery could be pretty significant and it requires pretty fine motor control.

So i guess if I were to answer this question, I'd probably touch on the issue of how much they had to drink a bit, but ultimately, I would still play it safe and not have them do the surgery- it still puts patient safety at risk. I'd think it'd definitely warrant a conversation with the physician, and it'd probably be smart to let some sort of supervisor know.
 
I agree. You would have to do or say something. State your concerns and put the patient's safety as the number one priority. When answering the question in an interview I would talk about the fact that the physician may or may not be intoxicated. Putting the patient at risk is not okay.

I am trying not to jump the gun on ethical questions (assuming things). I think if I can do this and express my thoughts clearly as I work through the issue I will do okay. My first instinct on another ethical question was to assume parts of the question.
 
I would address this by giving an overview of both possibilities: that he has been drinking, and that I have no idea if he is and I might be mistaken. I would discuss the obvious patient safety concern, and the concern for my colleague. Then I would talk about how I might ask him about it, because communication is important. If he had been drinking, I'd prevent him from taking over the patient, I'd make sure care was handed over to someone else, and I'd accompany him in a supportive role to whoever deals with this stuff. Drinking on the job stinks of personal problems that need real help, not someone that was out partying for fun.
 
the thing is...if you see that he or she drank before taking over the patient once, he or she actually probably did it numerous times..

im all for drinking on one's freetime but the surgeon in this scenario is crossing the line big time..

on a side note, has this happened numerous times before?
 
For purposes of interview. You have to put patient safety first. The real world is a bit difference

I've smelt alcohol on a quite a few patients that I thought were wasted, with BAL's of 0. Your nose isn't perfect.
 
I am sure it happens today but not nearly as bad as it used to years ago.
 
I think this is tricky because 99% of people are going to claim they would intervene, while the reality is that most people wouldn't, especially if the surgeon in question was in a higher position of authority. I mean, unless the surgeon is stumbling around and talking incoherently, most people are not going to question their superiors, especially since medicine is so hierarchial and your spot on the totem pole often comes down to what your superiors think of you. If I were to get this question, I might express these concerns as something like:

"Patient safety should always come first, but in this sort of situation, I believe alot of people's first instinct would be not to make waves, especially if you're the low man on the totem pole. Regardless, as physicians we take an oath to do no harm to our patients, and I believe an extension of that is to not knowingly put them in harms way. Allowing an individual that you suspect to be intoxicated operate on your patient would violate that oath, so in this situation, I would have to refuse to release the patient from my care until I was confident that the operating physian was able to safely perform his duties. I would hope that my decision would be respected, but my first duty is always to my patients."
 
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StephanieZ said:
I think this is tricky because 99% of people are going to claim they would intervene, while the reality is that most people wouldn't, especially if the surgeon in question was in a higher position of authority. I mean, unless the surgeon is stumbling around and talking incoherently, most people are not going to question their superiors, especially since medicine is so hierarchial and your spot on the totem pole often comes down to what your superiors think of you. If I were to get this question, I might express these concerns as something like:

"Patient safety should always come first, but in this sort of situation, I believe alot of people's first instinct would be not to make waves, especially if you're the low man on the totem pole. Regardless, as physicians we take an oath to do no harm to our patients, and I believe an extension of that is to not knowingly put them in harms way. Allowing an individual that you suspect to be intoxicated operate on your patient would violate that oath, so in this situation, I would have to refuse to release the patient from my care until I was confident that the operating physian was able to safely perform his duties. I would hope that my decision would be respected, but my first duty is always to my patients."
Click to expand...

I think you nailed it because you mention the realistic approach.

In my further research on medical ethic questions i discovered the AMA's medical ethics book. The AMA also has a brief description of medical ethics on their website. I am considering referring to this guide to help me with such and such situation in an interview question where I am struggling.
 
I came across 4 other ethical questions and was hoping some of you could help me out on these.


1) If you saw one of your senior colleagues fudging Medicare forms, what would you do? if you said you would confront him, he could tell you that you wouldn't be working for him anymore, what would you do?

(It depends on exactly what information he is changing. If he misspelled the patient's name with one or two letters wrong, it might not be as big of deal. But if it is about writing down the age of 65+ while the patient is actually 60, I think Medicare fraud and abuse should be reported, so I would see if I could contact a supervisor or another senior colleague for advice. But I am not sure what I would say especially if that senior colleague was my mentor and/or someone who would write me a letter.)


A similar question to the above is, you saw another colleague fudging Medicare forms for treating an illegal immigrant and what would you do?

(Usually the hospital has to absorb the cost for illegal immigrants coming into ER, or is it correct? Like the above, I think this Medicare fraud should be reported in this case as well, because changing the immigrant status from illegal to legal definitely appears to be a fraud.)

2) Young parents have a baby with Down syndrome as well as heart and lung defects. Surgery is necessary but not urgent. Parents only want healthy babies, and they do not want me to do the surgery to save the baby. Do I honor their requests?

(If it was about emergency, life-saving treatment, I know that usually the parents' will can be overruled through court orders especially when the denial is due to religious issues. But I also understand that usually parents' will can be honored when the baby is in a persistent vegetative state and the baby's ventilator and other equipments can be unattached. I am confused where exactly this particular scenario falls under.)

3) Prior to surgery, the patient denied of being HIV+, but during the surgery I accidentally cut myself and found out later that the patient lied and actually was HIV+. What do I do?

(Since getting a cut has been already done, we cannot go back. I think I have to clean my wounds as thoroughly as possible and look into HIV treatments if needed. But at the same time, the patient could have lied due to other social issues without any personal intention towards me as a doctor, so I don't think it is wise to sue the patient right away. So I would definitely ask a social worker for his/her input and see if there are other things I might be missing for the patient's treatment plans, but I am not exactly sure what to do step-by-step on this whole "getting cut" situation.)


Any advice will be appreciated!
 
Lya said:
3) Prior to surgery, the patient denied of being HIV+, but during the surgery I accidentally cut myself and found out later that the patient lied and actually was HIV+. What do I do?

(Since getting a cut has been already done, we cannot go back. I think I have to clean my wounds as thoroughly as possible and look into HIV treatments if needed. But at the same time, the patient could have lied due to other social issues without any personal intention towards me as a doctor, so I don't think it is wise to sue the patient right away. So I would definitely ask a social worker for his/her input and see if there are other things I might be missing for the patient's treatment plans, but I am not exactly sure what to do step-by-step on this whole "getting cut" situation.)


Any advice will be appreciated!
Click to expand...

3) Would you really want to mention being litigious towards a patient?
 
Deadlifts said:
3) Would you really want to mention being litigious towards a patient?
Click to expand...

I probably wouldn't since from my previous ECs, I came across many situations where patients lie because of sociocultural concerns, not because of personal issues with doctors.

But I have no idea what I would do step by step, besides seeking medical treatments for potential HIV.
 
Lya said:
I probably wouldn't since from my previous ECs, I came across many situations where patients lie because of sociocultural concerns, not because of personal issues with doctors.

But I have no idea what I would do step by step, besides seeking medical treatments for potential HIV.
Click to expand...

For interviews, just go with what is best for the patient. Look up benifecence and nonmalifecence in the context of patient care
 
Lya said:
I came across 4 other ethical questions and was hoping some of you could help me out on these.


2) Young parents have a baby with Down syndrome as well as heart and lung defects. Surgery is necessary but not urgent. Parents only want healthy babies, and they do not want me to do the surgery to save the baby. Do I honor their requests?

(If it was about emergency, life-saving treatment, I know that usually the parents' will can be overruled through court orders especially when the denial is due to religious issues. But I also understand that usually parents' will can be honored when the baby is in a persistent vegetative state and the baby's ventilator and other equipments can be unattached. I am confused where exactly this particular scenario falls under.)



Any advice will be appreciated!
Click to expand...


That's a tough one. I personally would talk about how a doctor's values may be different than the parent's; if ultimately they're refusing to care for a baby that can be treated only because they don't want an "unhealthy baby" then maybe looking into court orders would be an option; however from a physician point of view, I would say that it would be important to evaluate your own comfort level with the situation, and if it's something that you don't agree with or cannot do, it may be smart to ask them to find a new doctor and to remove yourself from the case in order to maintain both your comfort level and values as a physician. As physicians, you don't get to make decisions for patients generally, you get to treat them an recommend treatment options, so it'd be important to maintain your own scope of practice.
 
Lya said:
1) If you saw one of your senior colleagues fudging Medicare forms, what would you do? if you said you would confront him, he could tell you that you wouldn't be working for him anymore, what would you do?
Click to expand...

Ignore it.

Lya said:
2) Young parents have a baby with Down syndrome as well as heart and lung defects. Surgery is necessary but not urgent. Parents only want healthy babies, and they do not want me to do the surgery to save the baby. Do I honor their requests?
Click to expand...

Surgery is necessary but not urgent? Could you even get a court order for this scenario?

I'm a huge advocate for what the patient wants. We have to understand that the choices the patient makes isn't always what we would do for our loved ones. We aren't all-knowing. Just because something is possible doesn't mean we should do it.

Even with surgery, someone with heart and lung defects and down syndrome probably won't be living the best life. Artificially prolonging his/her life may not be the best choice.

Lya said:
3) Prior to surgery, the patient denied of being HIV+, but during the surgery I accidentally cut myself and found out later that the patient lied and actually was HIV+. What do I do?
Click to expand...

The reality of the situation is the patient probably doesn't have any money, so suing would probably be more detrimental than helpful.
 
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lol, how is that even a hard question? Obviously you tell him, "go home, you're drunk." Then you report him. Can't have surgeons coming to the job drinking enough that you can smell it on them. Off the job - they can get drunk to their heart's content.

Obviously, you aren't really going to report him in real life unless he doesn't stop after you suggest he do or until it gets serious, but technically you are supposed to report him right away.

It's funny. The basic moral mentality we're taught we should have is to just snitch on everyone, but no one actually does this in real life because there is too much risk involved for trying to rat someone out.
 
It's a great question, the scenario could very well happen, and you need to answer the question honestly.



jdfamily said:
I am preparing for interviews and came upon a question which I had difficulty in responding.

What would you do if you smelled a strong scent of alcohol on a surgeon who was taking over your patient?

This question applies to any scenario where you are working in a health care setting and suspect that a physician is under the influence.

I have my thoughts on it. I know we can't be prepared for every ethical question, but I do feel that this is one that really could happen to many of us as physicians.
Click to expand...
 
Ok, let's say that this surgeon with the alcohol breath is about to operate on an extremely critical patient who will probably die without the surgery. And let's say this neurosurgeon or trauma surgeon or whatever is the only one available to do the surgery, every other option has been exhausted. (I'm not sure how often this happens, but humor me.) Then what? Maybe the surgeon is a little buzzed but not hammered, do you let him/her continue knowing that the patient will die without emergency surgery, but also knowing the alcohol could cause him/her to make a deadly mistake?
 
jdfamily said:
I am preparing for interviews and came upon a question which I had difficulty in responding.

What would you do if you smelled a strong scent of alcohol on a surgeon who was taking over your patient?

This question applies to any scenario where you are working in a health care setting and suspect that a physician is under the influence.

I have my thoughts on it. I know we can't be prepared for every ethical question, but I do feel that this is one that really could happen to many of us as physicians.
Click to expand...
Tell her you need to speak in private. Then ask her if she's been hitting that bottle. If she says yes, ask for a shot 😀.

not srs.
 
Bookish said:
Ok, let's say that this surgeon with the alcohol breath is about to operate on an extremely critical patient who will probably die without the surgery. And let's say this neurosurgeon or trauma surgeon or whatever is the only one available to do the surgery, every other option has been exhausted. (I'm not sure how often this happens, but humor me.) Then what? Maybe the surgeon is a little buzzed but not hammered, do you let him/her continue knowing that the patient will die without emergency surgery, but also knowing the alcohol could cause him/her to make a deadly mistake?
Click to expand...
From a purely utilitarian point of view, obviously you let the surgeon go on. What's the alternative? Die? At least you have a shot for that person to live. Now in real life you can't do that because you'll get sued and probably lose your license and blah blah blah. And yes, I think protecting my license is more important. If I lose my license, a bunch of other people I could treat might go without or with mediocre treatment.
 
Bookish said:
Ok, let's say that this surgeon with the alcohol breath is about to operate on an extremely critical patient who will probably die without the surgery. And let's say this neurosurgeon or trauma surgeon or whatever is the only one available to do the surgery, every other option has been exhausted. (I'm not sure how often this happens, but humor me.) Then what? Maybe the surgeon is a little buzzed but not hammered, do you let him/her continue knowing that the patient will die without emergency surgery, but also knowing the alcohol could cause him/her to make a deadly mistake?
Click to expand...


Something similar happened to a family member. My uncle was in a bad car accident and the small town general surgeon who showed up to do the surgery reeked of alcohol and was slurring his words somewhat. My aunt worked in the hospital and knew the doc had a rep for hard drinking and refused to let him do the surgery and insisted they fly my uncle out to a different hospital at a larger facility. In retrospect the surgery was beyond this guys scope anyway, but my aunt was pissed that the nurse acknowledged there was a problem and smelled alcohol too, but wouldn't step in or report it. Guys still doing surgery.
 
Bookish said:
Ok, let's say that this surgeon with the alcohol breath is about to operate on an extremely critical patient who will probably die without the surgery. And let's say this neurosurgeon or trauma surgeon or whatever is the only one available to do the surgery, every other option has been exhausted. (I'm not sure how often this happens, but humor me.) Then what? Maybe the surgeon is a little buzzed but not hammered, do you let him/her continue knowing that the patient will die without emergency surgery, but also knowing the alcohol could cause him/her to make a deadly mistake?
Click to expand...

We have an ethical responsibility to our patients, a responsibility to maintain sobriety and a clear mind so that we can provide the best care possible.

It isn't about providing patients with the "best possible outcome" - if that were the case how would we train surgeons when a veteran was around?

This isn't LOST where we're stuck on an abandoned island in the middle of nowhere. Even if all the extremely unlikely circumstances were met that you mentioned, you would still get in trouble. If you were not sober you should have never walked into the OR in the first place.
 
I had an interview question today about alcohol which made me smile because it made me think of this post. It asked what if another med student and I in our third year get plastered one night. The next day I'm at the clerkship and she calls me to ask to cover for her to say she is too ill to come in today. Thought it was a much easie question. I got excited once I heard the interviewer mention the getting plastered part based on my original question in this forum.
 
jdfamily said:
I am preparing for interviews and came upon a question which I had difficulty in responding.

What would you do if you smelled a strong scent of alcohol on a surgeon who was taking over your patient?

This question applies to any scenario where you are working in a health care setting and suspect that a physician is under the influence.

I have my thoughts on it. I know we can't be prepared for every ethical question, but I do feel that this is one that really could happen to many of us as physicians.
Click to expand...

Indiana 😛

I feel like they ask everyone a question about EtOH. I had a question that asked if your medical school classmate asked you to cover for them but you could tell they were drunk what would you do. My main point was I would get them to contact the resident directly and that I wasn't going to make anything easy for them. It got slightly bumpy when the physician asked what about the patients that needed to have vitals/data gathered and I made sure to say yes I would do it but I would then alert the resident to let them know especially if I would be late or something coming back. Not the greatest answer but I tried to stay calm and keep my conviction. Probably the lowest point of the entire interview for me, I answered all other ethical prompts well and all the big stuff well too.
 
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