pitt moral dilemma question.....

[mango6110]

---

Members do not see this ad.

i was going to write about how i was treating patients by giving them injections and i came across an aids patient and i didnt have any gloves and i hesitated to treat them...in the end i did.....do u think this qualifies?

perhaps i could rexplain my dilemma....I worked in a rural hospital in Kenya where the hospital did not have enough resources to provide their staff with gloves. As student volunteers we did bring gloves but they were quickly used up. The day came when we had to deliver injections to our patients without using the necessary precautions such as gloves. And I happened to come across an AIDS patient. Now the dilemma was that I felt that as a prospective physician I am committed to providing medical care at the best of my ability. But my obvious question was at what cost? If I gave the patient the injection, I was endangering my own health, but my only other option was to pass that syringe to my colleague and then I would be endangering his. Either I would be delivering the injection or someone else. I ended up giving the injection but I did do whatever I could to protect myself. Now I wanted to know what the adcoms would think about that? I just did not feel at the time that I could feel comfortable delegating that responsibility on someone else...I feel as physicians we may be faced with adverse situations but I feel that does not give me the right to pass my responsibilities on others....I wanted to know if that is something that I coud write down or would it as many of you said looked upon negatively

Also, many of you commented on the fact that you wouldnt have given him the injection, but keep in mind I was not in America...things in foreign countries dont exactly follow the same rules and procedures that the hospitals here do....and many of them are not as fortunate to have even a tiniest sliver of the resources that we do

 

[VFrank]

If I were an adcom, I'd prolly say "why didn't you go find some gloves?" I don't think being unsafe is something that would appeal to a medical school.

 

[mango6110]

there were no gloves....i was working in a rural hospital in kenya....the dilemmea is whether or not to provide care to ure patients regardless.....

 

[kikkoman]

If I were an adcom, I'd prolly say "why didn't you go find some gloves?" I don't think being unsafe is something that would appeal to a medical school.

Yeah, it's not much of a "dilemma." I think it's hard to come up with something that is meaningful in that situation and that says something about your values.

I thought a lot about it, and ended up writing about a time where I had to choose between doing the "right thing" and protecting a friend's well-being. I ended up making a decision that I'm not sure was "moral", but I wrote about why I did it, and why, according to my core values, I couldn't make the other choice.

 

[Blake]

there were no gloves....i was working in a rural hospital in kenya....the dilemmea is whether or not to provide care to ure patients regardless.....

Off-topic : you worked in kenya ? That's quite interesting. Are you kenyan ?

 

[MoosePilot]

there were no gloves....i was working in a rural hospital in kenya....the dilemmea is whether or not to provide care to ure patients regardless.....

Unfortunately, there's not (in my opinion) a clear right answer in this case. So you may write about your choice only to find that the Adcom vehemently disagrees with it. That's not going to make you look good.

 

[stinkycheese]

Unfortunately, there's not (in my opinion) a clear right answer in this case. So you may write about your choice only to find that the Adcom vehemently disagrees with it. That's not going to make you look good.

I think there is a clear right answer, and that is to not treat the patient. Obviously, others will disagree, but I don't think this is an ethical dilemma, I think this is an issue of common sense. You don't expose yourself to bloodborne pathogens without taking the necessary precautions. It seems foolish to me to do otherwise. Hospitals even have policies that if an RN cannot start an IV with gloves on (its harder to get the vein when feeling through latex), then it shouldn't be started at all. It's just basic practice.

 

[MoosePilot]

I think there is a clear right answer, and that is to not treat the patient. Obviously, others will disagree, but I don't think this is an ethical dilemma, I think this is an issue of common sense. You don't expose yourself to bloodborne pathogens without taking the necessary precautions. It seems foolish to me to do otherwise. Hospitals even have policies that if an RN cannot start an IV with gloves on (its harder to get the vein when feeling through latex), then it shouldn't be started at all. It's just basic practice.

I would agree with you, but since the OP holds the opposing view, I'll admit that it's debatable, because to say otherwise is to disregard his opinion.

 

[stinkycheese]

I would agree with you, but since the OP holds the opposing view, I'll admit that it's debatable, because to say otherwise is to disregard his opinion.

Yes, I can see how many would feel this issue does not have a clear answer. I have had a close call with needlestick injury, so to me, there is not a doubt that safety must come first, but for the young idealists on the board 😉 I do understand that otheres may feel differently.

 

[mango6110]

perhaps i could rexplain my dilemma....I worked in a rural hospital in Kenya where the hospital did not have enough resources to provide their staff with gloves. As student volunteers we did bring gloves but they were quickly used up. The day came when we had to deliver injections to our patients without using the necessary precautions such as gloves. And I happened to come across an AIDS patient. Now the dilemma was that I felt that as a prospective physician I am committed to providing medical care at the best of my ability. But at what cost? If I gave the patient the injection, I was endangering my own health, but my only other option was to pass that syringe to my colleague and then I would be endangering his. Either it would be delivering the injection or someone else. So maybe that helps... I ended up giving the injection but I did do whatever I could to protect myself. Now I wanted to know what the adcoms would think about that? I just did not feel at the time that I could feel comfortable delegating that responsibility on someone else.....I wanted to know if that is something that I coud write down or would it as many of you said looked upon negatively

Also, many of you commented on the fact that you wouldnt have given him the injection, but keep in mind I was not in America...things in foreign countries dont exactly follow the same rules and procedures that the hospitals here do....and many of them are not as fortunate to have even a tiniest sliver of the resources that we do

 

[Jack_Adam]

Mango6110...maybe this is something you should discuss with any doctors you may know...how would they have responded to such a situation? None of us are on the adcoms at the schools to which you are applying. In all honesty, I would say stick with your gut instinct. You can't lie about the situation...so if you're asked about it, you must be able to defend yourself. What personal morals and values do you hold that compelled you to provide care to the infected patients without the proper precautionary measures? How did you assess the risk of being infected versus your desire to treat the patient/lack of desire to "pass on" the responsibility? Was it necessary to treat the patient at that moment, or could you have waited until the proper resources were available? If you could have waited, why didn't you? You must have answers to these questions (or be thinking about how you can answer them). These are the same dilemmas you'll face as a doctor. I think having this experience was probably a good thing and you have probably learned a great deal about yourself (or you will). I don't think adcoms will necessarily agree with your action, but more likely than not, they will respect the decision you made if you are able to provide a firm basis for why you made the decision. Think about it...you'll be okay. If you ask me, it's important to bring up. Even if medical schools think you were wrong, at best, you can explain that you were not at a mature level to handle that kind of situation, and that you hope the ethics and etc. courses at their medical school will better prepare you to handle such situations.

 

[Psycho Doctor]

Mango6110...maybe this is something you should discuss with any doctors you may know...how would they have responded to such a situation? None of us are on the adcoms at the schools to which you are applying. In all honesty, I would say stick with your gut instinct. You can't lie about the situation...so if you're asked about it, you must be able to defend yourself. What personal morals and values do you hold that compelled you to provide care to the infected patients without the proper precautionary measures? How did you assess the risk of being infected versus your desire to treat the patient/lack of desire to "pass on" the responsibility? Was it necessary to treat the patient at that moment, or could you have waited until the proper resources were available? If you could have waited, why didn't you? You must have answers to these questions (or be thinking about how you can answer them). These are the same dilemmas you'll face as a doctor. I think having this experience was probably a good thing and you have probably learned a great deal about yourself (or you will). I don't think adcoms will necessarily agree with your action, but more likely than not, they will respect the decision you made if you are able to provide a firm basis for why you made the decision. Think about it...you'll be okay. If you ask me, it's important to bring up. Even if medical schools think you were wrong, at best, you can explain that you were not at a mature level to handle that kind of situation, and that you hope the ethics and etc. courses at their medical school will better prepare you to handle such situations.

that was an excellent reply and i agree totally.

and to the OP, I don't necessatily think there is a right or wrong answer and i do think it can be used for a moral dilemna situation. For myself, as someone labeled us, i think being a "young idealist" i would have done the same as you. If the procedure was necessary and life-saving i would have taken whatever precautions i could have, considering the limitations, and given the patient the injection. I also wanted to comment tha ti think it is awesome that you worked in Kenya. How long did you do it? Was this part of some organization...Peace Corps, some other missionary work?

 

[MoosePilot]

Ultimately, I do think there's a right answer. Little risks over a lifetime of medicine will end up accumulating into a large risk. Further, I assume you're a young, healthy westerner. You have access to more than adequate medical treatment. You're giving a single injection to a poor AIDS patient. The patient doesn't have an indefinite lifespan. I understand in the US AIDS patients do have an indefinite lifespan due to the great medical treatment, but your patient doesn't have that luxury. So you're risking death and/or a lifetime of risk to third parties during what you have left of a medical career in order to give one injection to someone with a limited life span. Conceivably, you went on to make that same decision multiple times. I just can't come to that being a good decision. Wait a month and arrange for a large shipment of gloves.

Perhaps your time could have been better spent changing your focus from direct patient contact to logistical support, ensuring a large supply of gloves for the volunteers that followed.

 

[Psycho Doctor]

Ultimately, I do think there's a right answer. Little risks over a lifetime of medicine will end up accumulating into a large risk. Further, I assume you're a young, healthy westerner. You have access to more than adequate medical treatment. You're giving a single injection to a poor AIDS patient. The patient doesn't have an indefinite lifespan. I understand in the US AIDS patients do have an indefinite lifespan due to the great medical treatment, but your patient doesn't have that luxury. So you're risking death and/or a lifetime of risk to third parties during what you have left of a medical career in order to give one injection to someone with a limited life span. Conceivably, you went on to make that same decision multiple times. I just can't come to that being a good decision. Wait a month and arrange for a large shipment of gloves.

Perhaps your time could have been better spent changing your focus from direct patient contact to logistical support, ensuring a large supply of gloves for the volunteers that followed.

I'd actually want to know what kind of injection it was before icould realistically make an educated decison.

 

[MoosePilot]

I'd actually want to know what kind of injection it was before icould realistically make an educated decison.

What if it was a shot that would absolutely save his life? You're only realistically gaining him five years, since he's an AIDS patient (not HIV) in a medically backwater area.

If you really want to get into the weeds, once you knew what kind of injection, you could teach him to give it to himself. Train him right and he could administer shots to his fellows. Give a man a fish and all that...

 

[Psycho Doctor]

What if it was a shot that would absolutely save his life? You're only realistically gaining him five years, since he's an AIDS patient (not HIV) in a medically backwater area.

If you really want to get into the weeds, once you knew what kind of injection, you could teach him to give it to himself. Train him right and he could administer shots to his fellows. Give a man a fish and all that...

Great answer!!

and perhaops i am too idealistic and most likely will change..but i can not see ever leaving a patient to die prematurely for failing to administer something that would ultimately save his life even for a short while.

i mean what about an EMT who does not know if someone has AIDS, what if they are all bloody and, or you have to give CPR; i realize both include some sort of barrier but there ar eno guarantees. what if a needle penetrates the glove...?

 

[MoosePilot]

Great answer!!

and perhaops i am too idealistic and most likely will change..but i can not see ever leaving a patient to die prematurely for failing to administer something that would ultimately save his life even for a short while.

i mean what about an EMT who does not know if someone has AIDS, what if they are all bloody and, or you have to give CPR; i realize both include some sort of barrier but there ar eno guarantees. what if a needle penetrates the glove...?

The difference is that at least you're taking some basic precautions. Maybe it's not that big a difference, because a glove isn't armor, but I just can't see going over to volunteer and not taking care of myself. Idealism is great, but you can get yourself killed for little return.

 

[Psycho Doctor]

The difference is that at least you're taking some basic precautions. Maybe it's not that big a difference, because a glove isn't armor, but I just can't see going over to volunteer and not taking care of myself. Idealism is great, but you can get yourself killed for little return.

without gloves a person can put their hands in a plastic bag, wrap rags or clothing around their hands first, each are slight barriers but offer some protection and no guarantees. i'd be creative and find some resource to use but would not abandon care

and since i'm the only person besides the OP who would have given the injection, feel free to ctiticize my actions. at least i'd go to bed that night knowing i did all i could for the patient

 

[MoosePilot]

without gloves a person can put their hands in a plastic bag, wrap rags or clothing around their hands first, each are slight barriers but offer some protection and no guarantees. i'd be creative and find some resource to use but would not abandon care

and since i'm the only person besides the OP who would have given the injection, feel free to ctiticize my actions. at least i'd go to bed that night knowing i did all i could for the patient

Well, I disagree with you, but I don't feel the need to criticize.

The way I look at it, is that you're planning on making medicine your life's work. If you're wise and careful, avoid getting a deadly disease, then you can help people for the next 40+ years. If you're so idealistic you'll help people without taking basic precautions, then you might end up with a deadly disease. You can still help people, but now you risk spreading your disease. It's just not good.

There's lots of good alternatives. By putting your head down and continuing to give injections, you don't fix the process. If you pull yourself out of the day to day work and improve the process, by arranging for a supply of gloves, then you help everyone. Sometimes it's important to work with a broken process, but often it's better to take the time and fix the process so the work proceeds quicker and better.

 

[Fusion]

i was going to write about how i was treating patients by giving them injections and i came across an aids patient and i didnt have any gloves and i hesitated to treat them...in the end i did.....do u think this qualifies?

In answer to your original question, I think it would be safe to say that, yes, this particular experience qualifies.

 

[Psycho Doctor]

Well, I disagree with you, but I don't feel the need to criticize.

The way I look at it, is that you're planning on making medicine your life's work. If you're wise and careful, avoid getting a deadly disease, then you can help people for the next 40+ years. If you're so idealistic you'll help people without taking basic precautions, then you might end up with a deadly disease. You can still help people, but now you risk spreading your disease. It's just not good.

There's lots of good alternatives. By putting your head down and continuing to give injections, you don't fix the process. If you pull yourself out of the day to day work and improve the process, by arranging for a supply of gloves, then you help everyone. Sometimes it's important to work with a broken process, but often it's better to take the time and fix the process so the work proceeds quicker and better.

well i agree with yiou but the OP did not give us enough information to clearly make a decision. Was there time to order gloves and to teach the AIDS patient to administer his own injection? If not i still feel there are other alternatives that are safer than going in ther and doing it without taking any precautions.

Now why would one who picks up a "deadly disease" risk spreading it to other patients if he uses universal precautions at all times? I'm talking about in the US now, not in a backwards country.

 

[MoosePilot]

well i agree with yiou but the OP did not give us enough information to clearly make a decision. Was there time to order gloves and to teach the AIDS patient to administer his own injection? If not i still feel there are other alternatives that are safer than going in ther and doing it without taking any precautions.

Now why would one who picks up a "deadly disease" risk spreading it to other patients if he uses universal precautions at all times? I'm talking about in the US now, not in a backwards country.

How many injections are time critical? And if it was a time critical injection, what are the chances the patient is going to live if the only medical care is a pre-med with inadequate resources?

Universal precautions are only so good. If a patient can transmit to a doc despite precautions (needle stick through gloves, scalpel slips) then the reverse is also true. If you were to cut yourself while you had your hands in a patient, the patient is going to have some serious problems.

 

[Psycho Doctor]

How many injections are time critical? And if it was a time critical injection, what are the chances the patient is going to live if the only medical care is a pre-med with inadequate resources?

Universal precautions are only so good. If a patient can transmit to a doc despite precautions (needle stick through gloves, scalpel slips) then the reverse is also true. If you were to cut yourself while you had your hands in a patient, the patient is going to have some serious problems.

i don't know what injections are so time critical..i hope to learn that in med school 😀 I was hoping the OP coul provide more information

so you think if a doctor has Hep C or HIV they shouldn't be practicing medicine? what's the answer?

 

[MoosePilot]

so you think if a doctor has Hep C or HIV they shouldn't be practicing medicine? what's the answer?

My personal opinion right at this moment is that a Hep C or HIV positive doc probably shouldn't do procedures. Why chance that when there are plenty of other doctors to do procedures and plenty of non-procedural jobs for the doc?

Alternatively, the doc could do something really great and tailor their practice to care for patients infected with the same thing.

 

[Psycho Doctor]

My personal opinion right at this moment is that a Hep C or HIV positive doc probably shouldn't do procedures. Why chance that when there are plenty of other doctors to do procedures and plenty of non-procedural jobs for the doc?

Alternatively, the doc could do something really great and tailor their practice to care for patients infected with the same thing.

No procedures? So what do you suggest they do? Wha tkind of doctor can they be without jeopardizing their patients? Do you have any idea how many people test positive for Hep C? it's a national epidemic. What if it's been treated and they don't have the disease any more but they still have antibodies for it meaning they can't ever donate blood? Many peple live with Hep C without ever knowing they have the disease and it can remain dormant and never cause them a problem. So i can see an HIV positive doctor tailor a practice to AIDS patients but most of the time Hep C patients are patients just like you and me who have the potential to live a normal life.

 

[mango6110]

thank you guys for all your great advice...the problem was that i was only there for 2 months....and the doctors and nurses that regularly work there
are used to not using gloves

But i felt at the time that i was given a responsibiity and I did not think that i should pass that along to someone else....we couldnt wait a month.....i did use a plastic bag over my hand.....so i felt protected,

to me this is rather relevant cause i would like to work in hospitals internationally, i just wanted to know if adcoms would find this disturbing or understand the experien ce

 

[MoosePilot]

No procedures? So what do you suggest they do? Wha tkind of doctor can they be without jeopardizing their patients? Do you have any idea how many people test positive for Hep C? it's a national epidemic. What if it's been treated and they don't have the disease any more but they still have antibodies for it meaning they can't ever donate blood? Many peple live with Hep C without ever knowing they have the disease and it can remain dormant and never cause them a problem. So i can see an HIV positive doctor tailor a practice to AIDS patients but most of the time Hep C patients are patients just like you and me who have the potential to live a normal life.

Lots of doctors don't do procedures. Your average FP does very few. I suggest they don't do procedures. Perhaps work in a practice with someone who enjoys doing procedures and let the partner cover them all.

 

[Psycho Doctor]

Lots of doctors don't do procedures. Your average FP does very few. I suggest they don't do procedures. Perhaps work in a practice with someone who enjoys doing procedures and let the partner cover them all.

doesn't do much for someone who wants to practice surgery 👎

 

[Psycho Doctor]

thank you guys for all your great advice...the problem was that i was only there for 2 months....and the doctors and nurses that regularly work there
are used to not using gloves

But i felt at the time that i was given a responsibiity and I did not think that i should pass that along to someone else....we couldnt wait a month.....i did use a plastic bag over my hand.....so i felt protected,

to me this is rather relevant cause i would like to work in hospitals internationally, i just wanted to know if adcoms would find this disturbing or understand the experien ce

just curious, what was the injection for? i would have done the same as you as i indicated somewhere in this thread. I would think the adcoms should understand.

 

[MoosePilot]

doesn't do much for someone who wants to practice surgery 👎

Too darn bad. Somebody's wants take a big backseat to not passing on a chronic/potentially deadly infection.

 

[indiamacbean]

While this is one of the more drawn out threads I've seen beating a topic to death, I think it would be a fine topic to write your essay about. As a current Pitt student and someone who interviews and spends a lot of time in the admissions office, it seems TO ME (not speaking for anyone else here) that this is a compelling topic and one in which you did not make a choice which is indefensible. I think that many people who haven't spent time in developing countries don't have any good idea about medical necessity and available supplies. The truth of the matter is that the people on this thread who are screaming about total BSI need only stroll down to the local VA, health department or busy urban ER to see the old school doctors and nurses doing this all the time. Is it right? no. is it going to keep you out of medical school if you tell someone? absolutely not. I mean really, how hard is it to give a shot in a calm adult patient without sticking yourself if you are paying attention?

 

[Psycho Doctor]

While this is one of the more drawn out threads I've seen beating a topic to death, I think it would be a fine topic to write your essay about. As a current Pitt student and someone who interviews and spends a lot of time in the admissions office, it seems TO ME (not speaking for anyone else here) that this is a compelling topic and one in which you did not make a choice which is indefensible. I think that many people who haven't spent time in developing countries don't have any good idea about medical necessity and available supplies. The truth of the matter is that the people on this thread who are screaming about total BSI need only stroll down to the local VA, health department or busy urban ER to see the old school doctors and nurses doing this all the time. Is it right? no. is it going to keep you out of medical school if you tell someone? absolutely not. I mean really, how hard is it to give a shot in a calm adult patient without sticking yourself if you are paying attention?

well that's what i would have thought too, and thus i was the only other person to support the OP's actions

 

[Psycho Doctor]

Too darn bad. Somebody's wants take a big backseat to not passing on a chronic/potentially deadly infection.

ok that sorta sucks

 

[neuronerd]

In answer to your original question, I think it would be safe to say that, yes, this particular experience qualifies.

Agreed. This is obviously a dilemma (in contrast to what others have posted) if there's this much discussion about it. I think that in an ideal world, you might have been able to take a day off, find a cure for AIDS and cancer, get a shipment of gloves along with fundraising enough money to stop third world hunger, but I think that the point of this question was a dilemma that requires a quick decision based on your OWN moral or ethical values. Although other posters are WAY more knowledgeable than me in subjects such as adcoms and medical procedures, I think that the point was that you were in Kenya for a limited period of time, you saw probably WAY too many patients a day anyway and the chances that the patient would come back to get the shot at another time would not have been very high since they might hae travelled far to get there (I watch too much TV maybe?). I think if you explain all the issues that lead you to your decision, that is the important thing. The thought process.

 

[pikachu]

One piece of information (that the person evaluating your application will almost certainly know) you might want to arm yourself with in this case is that the rate of HIV infection post-needlestick is actually quite low, less than 1/300. It is essentially zero with needles used to give a simple IM/sub-Q injection (1/300 relates to using a needle, such as one used to draw blood, that will actually inoculate you with HIV+ blood.)

Please do not take this post to suggest that you should not take the appropriate universal precautions when necessary (and possible). However, in this case, the benefit to the patient from the injection (what was it, incidentally?) far outweighed whatever risk to your own health you were incurring by injecting him without gloves. If you are going to use this situation, please take this under consideration. You will look like you're not willing to even take a slight risk to your own health in order to take care of your patients. Needlesticks are a fact of life on the wards (I am a fourth year med student), even with US-quality protective gear, and you might not want to seem too squeamish about these issues. Good luck with your applications.

 

[stinkycheese]

One piece of information (that the person evaluating your application will almost certainly know) you might want to arm yourself with in this case is that the rate of HIV infection post-needlestick is actually quite low, less than 1/300. It is essentially zero with needles used to give a simple IM/sub-Q injection (1/300 relates to using a needle, such as one used to draw blood, that will actually inoculate you with HIV+ blood.)

Actually, in the US, its 1/1000 for a needle that is known to have HIV. Excellent odds, but since I have had a needlestick before, I wouldn't put myself unnecessarily in harm's way with a known-positive patient. And I do believe that doing an injection without gloves on a known-positive patient is unnecessarily risky, yes.