Ethical question

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Wardles888

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I do shift work and often follow up on patients after they are no longer my patients but still in the hospital for learning purposes. Sometimes I run into an ethical quandary where I disagree with the next doctors management. I wonder how others handle these types of situations? Do you bring it up to your colleague? What if you barely know the colleague? Ie you are moonlighting for one random weekend shift, ect.

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I do shift work and often follow up on patients after they are no longer my patients but still in the hospital for learning purposes. Sometimes I run into an ethical quandary where I disagree with the next doctors management. I wonder how others handle these types of situations? Do you bring it up to your colleague? What if you barely know the colleague? Ie you are moonlighting for one random weekend shift, ect.

Leave it.

No longer your patient after you signed off. Obviously, if it’s something sooo outrageous, talk to the division chief. But hopefully it’s never THAT bad.
 
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Technically they are no longer your pt and you really shouldn’t be looking in the chart...so if you are worried about ethical issues...that’s one anyway.

if it is a difference in practice...let it go...there are different ways to treat.
If it is a concern for pt safety, then you may have a leg to stand on, but then may have to explain why you are accessing the chart.
 
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So basically a disagreement in management style ?? Nothing that you can do or should do again unless the physician is trying to literally doing his best to kill the patient. If I ever come across this when I go off service, I use it as a learning exercise to see what I could have done differently/better etc in my patient care ..... As the ethics consult team at my shop likes to phrase it in their consult notes..... we do not believe that there is an ethical dilemma at this time
 
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Not just a difference in management style. Let’s say the physician is choosing a medication that could potentially harm the patient
 
Technically they are no longer your pt and you really shouldn’t be looking in the chart...so if you are worried about ethical issues...that’s one anyway.

if it is a difference in practice...let it go...there are different ways to treat.
If it is a concern for pt safety, then you may have a leg to stand on, but then may have to explain why you are accessing the chart.
Not looking would be an easy fix to the problem lol but I feel like following up (a few days after I saw them not years) is such a valuable educational opportunity. Am I alone in doing this?
 
That's pretty vague. Just about everything we do could potentially harm a patient.
 
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Technically they are no longer your pt and you really shouldn’t be looking in the chart...so if you are worried about ethical issues...that’s one anyway.

if it is a difference in practice...let it go...there are different ways to treat.
If it is a concern for pt safety, then you may have a leg to stand on, but then may have to explain why you are accessing the chart.
Meh, you're allowed to follow up on patients you cared for.
 
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Not just a difference in management style. Let’s say the physician is choosing a medication that could potentially harm the patient
Not your circus anymore. What you do depends on your personal convictions and practice environment--Are you employed? Is this a private practice partner? Is this person more established and politically powerful than you? How much do your trust your department chair? Is it egregious enough to create a hostile work environment?

There is definitely no ethical dilemma--you aren't IM Batman tasked with going through every chart in the hospital to make sure optimal care is being given and doling out punishment when it isn't. In the ICU I sometimes get people that got very sick because they were mismanaged on the floor--I try to guard against casting aspiration internally or externally against anyone because I dont know the exact circumstances decisions were made and in some cases I am more experienced with managing a certain problem so what is clear to me may not be that way to others. Similarly sometimes I screw up and I would hope the people who catch my errors (eg consultants) dont think they need to report me for missing something from time to time (and there is a peer review process for egregious cases anyways).
 
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Technically they are no longer your pt and you really shouldn’t be looking in the chart...so if you are worried about ethical issues...that’s one anyway.

if it is a difference in practice...let it go...there are different ways to treat.
If it is a concern for pt safety, then you may have a leg to stand on, but then may have to explain why you are accessing the chart.
You can follow up on patients that were under your care..that’s not an ethical issue
 
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You can follow up on patients that were under your care..that’s not an ethical issue
According to hipaa, only those who are directly involved in the care of the patient and need access are allowed to review a patient’s chart. You won’t likely get caught but there’s a good reason for it.
 
According to hipaa, only those who are directly involved in the care of the patient and need access are allowed to review a patient’s chart. You won’t likely get caught but there’s a good reason for it.
Education is one of those exceptions
 
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Education is one of those exceptions
True story--a resident looked up a patient a week later to figure out what the mystery diagnosis was and disappeared the next day. Never heard from him again--pretty sure the HIPPAA police abducted him and took him to Gitmo.
 
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True story--a resident looked up a patient a week later to figure out what the mystery diagnosis was and disappeared the next day. Never heard from him again--pretty sure the HIPPAA police abducted him and took him to Gitmo.

I would hope there is something else, rather than just look at someone’s chart that you took care of a week ago.

“I ordered a test, I forgot the check the result...”
“I am considering writing a case report.”
“Dr. Consultant asked me about her patient....”

Especially for resident at a teaching hospital....? I find it little hard to comprehend.

OP, I am not sure how far along are you in your training/practice. There are plenty of times maybe I would not consider a drug, but it’s either local culture or some other forces that you don’t know about, that can prevent that. Isn’t adaptation of new drugs/procedure/intervention usually take more than 10 years?

I’ve always thought amiodarone is a dirty drug.... and multaq was going to replace it.. this was a while ago, when I was in training. My current hospital, I swear everyone is on it for their cardiac problems.

Unless they’re harming the patient right there and then, there isn’t much you can do. Talk to people who are in charge/above you and the other person. Talk to your colleague, who is on the patient’s case now.

However, the scenario can be more complicated if you’re a locum/traveler/part timer vs a mid-level.
 
I would hope there is something else, rather than just look at someone’s chart that you took care of a week ago.

“I ordered a test, I forgot the check the result...”
“I am considering writing a case report.”
“Dr. Consultant asked me about her patient....”

Especially for resident at a teaching hospital....? I find it little hard to comprehend.

OP, I am not sure how far along are you in your training/practice. There are plenty of times maybe I would not consider a drug, but it’s either local culture or some other forces that you don’t know about, that can prevent that. Isn’t adaptation of new drugs/procedure/intervention usually take more than 10 years?

I’ve always thought amiodarone is a dirty drug.... and multaq was going to replace it.. this was a while ago, when I was in training. My current hospital, I swear everyone is on it for their cardiac problems.

Unless they’re harming the patient right there and then, there isn’t much you can do. Talk to people who are in charge/above you and the other person. Talk to your colleague, who is on the patient’s case now.

However, the scenario can be more complicated if you’re a locum/traveler/part timer vs a mid-level.
You're right academic curiosity should be discouraged in academics
 
Our local EMR forces you to identify your role before looking into a chart. Attending, consultant, etc. “Continuing education” is an option as well. I’m pretty sure educational purposes was listed as an exception when I was being taught this stuff.
 
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Our local EMR forces you to identify your role before looking into a chart. Attending, consultant, etc. “Continuing education” is an option as well. I’m pretty sure educational purposes was listed as an exception when I was being taught this stuff.
It definitely is, looking up patients to learn how you could’ve done things differently is one of the most valuable learning tools we have
 
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It definitely is, looking up patients to learn how you could’ve done things differently is one of the most valuable learning tools we have
Yes but it’s not for you to then go tell the person that is now taking care of the pt that the way they are treating is incorrect..that’s just nosy and a bit arrogant
 
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Yes but it’s not for you to then go tell the person that is now taking care of the pt that the way they are treating is incorrect..that’s just nosy and a bit arrogant
I agree
 
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I disagree with some of this sentiment. If there is a significant risk of harm to the patient from the treatment, you have an ethical obligation to notify the attending or someone on the care team (eg if it is a resident patient). This is not criticizing someone for a mistake that they made after-the-fact, which has been mentioned above, but rather you are preventing an error.

The method of notification would depend on the culture at the hospital. I've worked at hospitals where everyone is checking email all the time and using it to discuss serious patient care (eg among the primary team and consultants) and there is an expectation of checking your email all the time. In that case I might send an email to the attending, say I was f/u on the pt I admitted, and it seemed to you the treatment should be xyz and you wanted to make sure they didn't miss it. So it sounds like you are helping out. Or if it's a non-email hospital, resident pt, tell the resident you were thinking that it was xyz and can they discuss it with their attending. If you are next to the attending in-person, mention it. B/c then they have the chance to respond and maybe there is a good reason for their management of which you are not aware.

If I explain myself and the other person disagrees with me, then I typically drop it at that point, since there is no question that it is something they inadvertently missed, etc.
 
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