Witnessing a colleague infusing pro-life ideas into a patient

[futuredo32]

That sounds like a God-awful way to suggest it. It's a very, very, very thinly-veiled gesture of contempt.

It was the nicest way that I could think of that might actually help the other student not look bad. (saying the other student did something well and saying that both students would benefit from seeing both sides of an ethical issue presented.) I'm sure there are better ways of stating it, but it was the best I could come up with at the moment.

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[GoBuckeyes913]

There is nothing wrong with a doctor expressing his or her views on a subject that I'm sure this collegue of yours finds as a matter of chosing between life and death (analogies to Auschwitz are not uncommon among pro-lifers when it comes to abortion).

There isn't anything wrong with a doctor expressing an opinion..... if they are asked for it FIRST.

That's ridiculous. It's silly to assume that we can counsel patients without crossing into realms considered "political." I don't believe it's realistic to find someone truly neutral on any such topic.

Really???? I do agree that it's unrealistic to find someone truly neutral, but unless our own personal opinion is asked we have to present options to patients unbiased first.

I completely agree with this. We are humans, we have opinions, and lets face it, no one really gives ALL the options of treatment to EVERY patient in those 20 minute appointments. We are all biased and will present our favorite options as the best ones. I have seen my preceptor time and time again advise his favorite option to the patient and then may even give another option but make it sound undesirable.

Suggesting to a patient what antihypertensive agent to take vs. the options regarding a DS pregnancy are completely different. Just sayin.

I thought that one of the core rules in third year was just not to make anyone look bad - whether that be your classmate, your intern, or yourself. If you do something that you know will make someone else look bad, you just look like a conniving tattle, which doesn't earn you points with ANYONE.

I'm not a fan of selling out anyone, but at the same time this family might make a decision in the long run they may regret, especially after hearing a biased opinion from someone with very minimal clinical experience (no offense, but true). Caring for a handicapped child is very complicated, and may create hardships for the family they are not prepared for and may not be able to handle. Obviously these issues may be addressed and questions appropriately answered when the patient inquires more information. For this reason, both sides should have been thouroughly presented to the patient so they can make an informed decision that best suits them.
We were taught to inform patients neutrally on matters like this, only to express our own opinion if the patient specifically asked for it.

 

[8744]

...Then how would you suggest helping this particular patient? We can't assume they will get any other input. Hopefully, they did, but we can't be sure of that.

Hey. Here's an idea. Forget about it. Let the patient do their thing and you do yours. Do you really care? Of course not. The concern is more that a conservative medical student managed to give some advice under the radar of the thought police and if you let this go by we may have human sacrifice, dogs and cats living together... mass hysteria!

Picture this phone conversation:

"Hello, Mrs. Smith...you may not remember me but I was the other medical student in the room...oh..I'm fine, thanks for asking...listen, I think you should abort your baby..."

 

[8744]

I could say the same about "conservatives" but that would be juvenile to stoop to name calling while adding nothing productive to a serious discussion. Why do you always paraphase every insult with "liberals are <insert negative pejorative>"? You have some well though out ideas but I always feel it's a backhanded slap towards those that are liberally inclined. No all liberals are caricatures you make them out to be. I think it shows maturity if you could stick to why you believe this way without having to insult a group of people who may or may not agree with you...

Yeah, but you see, I don't profess to be totally tolerant of everything or completely open-minded. (In fact, there are probably a whole bunch of things that you believe that I think are completely ridiculous and some that are even sublimely absurd.) You can search SDN and my now defunct blog and find nothing to suggest that I worship at the altar of tolerance or sing paens to openmindedness.

What Lenin meant, and he was speaking about revolutionaries, not liberals, was that inside the heart of every revolutionary burns a puritanical flame that is intolerant of every idea except those consistent with his belief and that he has a policeman's zeal to stamp them out.

Likewise, the original poster's beliefs are so puritanical that he is on the brink of ratting out one of his colleagues for a violation of his own morality, hopefully to have the unlucky colleague talked-to, counseled, or thrown into a gulag...whatever it takes to stamp out dissent.

 

[8744]

...Since the situation passed, I'd definitely say something to the student, perhaps print an article for the student about how to present both sides of an issue to a patient.

Good Lord. There are some places and some profession where this kind of toolishness could earn the student a well-deserved ass-kicking.

Are you guys for real? Didn't you all learn anything about working with other people and not being a tool when you were growing up?

 

[futuredo32]

Hey. Here's an idea. Forget about it. Let the patient do their thing and you do yours. Do you really care? Of course not. The concern is more that a conservative medical student managed to give some advice under the radar of the thought police and if you let this go by we may have human sacrifice, dogs and cats living together... mass hysteria!

Picture this phone conversation:

"Hello, Mrs. Smith...you may not remember me but I was the other medical student in the room...oh..I'm fine, thanks for asking...listen, I think you should abort your baby..."

I really don't have a strong opinion either way on the Pro-Choice vs Pro-Life issue. We were taught that in cases like this, we should present the facts to patients in the most unbiased manner possible and if we can't do that (and obviously the student involved didn't do that), the patient should be referred to someone who can. It's not that I think they should abort the fetus or not. Those parents heard about the risks involved in an abortion and were told that babies with Downs can still be cute.🙄

 

[futuredo32]

Good Lord. There are some places and some profession where this kind of toolishness could earn the student a well-deserved ass-kicking.

Are you guys for real? Didn't you all learn anything about working with other people and not being a tool when you were growing up?

Aren't we supposed to be helping patients? I realize that you are pro-life and you don't think that the other student in the room did anything wrong at all. Based on what we were taught, what the other student did was unethical. Your bias prevents you from seeing that, which is pretty obvious since you compared this situation to counselling a patient about smoking cessation. You're really good with the sarcastic remarks, but not much else in this discussion.

 

[8744]

Aren't we supposed to be helping patients? I realize that you are pro-life and you don't think that the other student in the room did anything wrong at all. Based on what we were taught, what the other student did was unethical. Your bias prevents you from seeing that, which is pretty obvious since you compared this situation to counselling a patient about smoking cessation. You're really good with the sarcastic remarks, but not much else in this discussion.

Not being a tool transcends politics. Pro-life, pro-choice, doesn't matter. To print an article and try to lecture a colleague on professionalism is an ass-kicking offense anywhere. It is well, well beyond the pale of what is considered civil behavior among friends, colleagues, and equals and will make you the laughingstock of your class as the word gets around.

 

[8744]

Aren't we supposed to be helping patients?

You're done helping this patient. Let it go. You practice medicine your way and let your colleagues practice it theirs.

 

[dienekes88]

Would you be all up in arms about this if only the abortion side was presented? Of course not. You'd probably be posting a thread lauding your progressive and level-headed colleague. There's your bias.

Panda, as abrasive as he may be, got this one right on the head...

 

[smq123]

If it were me, I'd be glad that someone took the time to print off an article for me. I had a horrible time on anesthesia and another student gave me a few google links to watch intubation videos. I didn't ask for the links, but she clearly saw that this was an area that I was really lacking in and needed some help! Was I insulted? Not at all. Another student helped me out with learning to tie knots on my surgery rotation. I didn't ask for the help, I wasn't offended and I wouldn't have passed the rotation without that help.

For things that are objective - sure, jumping in to help your classmates learn is fine. But the examples that you mentioned are objective. Either you can intubate or you can't. Either you can tie knots or you can't.

But the OP's example is highly, highly subjective. Things like professionalism and ethics are so colored by our own personal experiences and backgrounds, that, unless you have a LOT of clinical experience, I really do not believe that you are qualified to "teach" anyone how they should behave with patients. Furthermore, the idea of an MS3, with minimal clinical experience, would try to "teach" a fellow MS3 on professionalism is disturbing to me.

I guess I'm confused as to why you keep insisting that your approach is correct. It seems very clear to me that, if you were the OP, the OP's classmate would be angry, defensive, and (above all) embarrassed if you were to point out her shortcomings in front of the attending. She's not going to learn anything (because she'll be too angry to really learn), and she's not going to revise her approach. So, you haven't done her future patients any real favors.

A lot of residents are told not to embarrass the student in front of other residents, nurses, or attendings. While it is important to correct a student when they make a mistake, it is NOT necessary to do so in front of an audience - which is, essentially, what it seems like you are advocating. The fact that a fellow third year would point out his classmate's "mistake" to the attending just makes the situation worse.

In this case, there are DEFINITELY things that the OP could have done/said in the room. Is there anything wrong with the OP saying, "Well, as my classmate has demonstrated, we all have our own ideas about this. But, even though my classmate brought up excellent points, I'm sure that she agrees with me that a decision of such magnitude should not be made after talking to only one or two people. The decision needs to be made after talking to many people, getting many opinions, and considering your options carefully."

Or the OP could have spoken up before his classmate really opened her mouth, and said "Well, neither of us are comfortable discussing such a serious decision with you, particularly because we are both at the very beginning of our clinical training. If you like, we will get the senior physician, who has more experience with such matters." I would even have interrupted my classmate and said, "Well, before you really get into the discussion, I think that the senior physician, who is in charge of this particular patient's care, should at least be present at such a serious discussion. Let's go get him and we'll be right back."

There are lots of ways that the OP could have handled it without unduly embarrassing his classmate.

P.S. You can dismiss PandaBear all you want, but he is right in that inter-colleague behavior transcends politics. For the record, I'm pretty strongly pro-life, and I don't agree with what the OP's classmate did. That being said, I'm not advocating that OP run to his attending and subtly rat out his colleague. That's not professional either, it's ineffective, and it's (frankly) a cop-out.

 

[neuroprotector]

Can I just say that we need to do a better job (not just in this thread, but a lot of them) of distinguishing between someone's belief and their argument? It totally poisons the well to say that "person X is only saying that because they're pro-Y."

Someone's stance on an issue is entirely irrelevant to the strength of their argument. So shut up already.

 

[45408]

Not being a tool transcends politics. Pro-life, pro-choice, doesn't matter. To print an article and try to lecture a colleague on professionalism is an ass-kicking offense anywhere. It is well, well beyond the pale of what is considered civil behavior among friends, colleagues, and equals and will make you the laughingstock of your class as the word gets around.

Agreed. If someone were to broach this topic with me, a face-to-face conversation is the only way to go.

 

[futuredo32]

Not being a tool transcends politics. Pro-life, pro-choice, doesn't matter. To print an article and try to lecture a colleague on professionalism is an ass-kicking offense anywhere. It is well, well beyond the pale of what is considered civil behavior among friends, colleagues, and equals and will make you the laughingstock of your class as the word gets around.

I still don't think it's offensive. The student who presented a pathetic one-sided opinion to the parents violated everything that we were taught about medical ethics. Just telling the student that the other side should have presented would sound like my opinion and nothing more. Providing the student with an article written by medical ethicists would provide a different view. Not informing the student of the ethical violation they committed would be silently agreeing with what they did and that's something I wouldn't and couldn't do.

I don't see myself in the same position that the OP was in because attendings that I have worked with would not allow students to see patients like this without an attending present if at all. If it does happen, I'll be sure to post the outcome.😎

 

[futuredo32]

For things that are objective - sure, jumping in to help your classmates learn is fine. But the examples that you mentioned are objective. Either you can intubate or you can't. Either you can tie knots or you can't.

But the OP's example is highly, highly subjective. Things like professionalism and ethics are so colored by our own personal experiences and backgrounds, that, unless you have a LOT of clinical experience, I really do not believe that you are qualified to "teach" anyone how they should behave with patients. Furthermore, the idea of an MS3, with minimal clinical experience, would try to "teach" a fellow MS3 on professionalism is disturbing to me.

I guess I'm confused as to why you keep insisting that your approach is correct. It seems very clear to me that, if you were the OP, the OP's classmate would be angry, defensive, and (above all) embarrassed if you were to point out her shortcomings in front of the attending. She's not going to learn anything (because she'll be too angry to really learn), and she's not going to revise her approach. So, you haven't done her future patients any real favors.

A lot of residents are told not to embarrass the student in front of other residents, nurses, or attendings. While it is important to correct a student when they make a mistake, it is NOT necessary to do so in front of an audience - which is, essentially, what it seems like you are advocating. The fact that a fellow third year would point out his classmate's "mistake" to the attending just makes the situation worse.

In this case, there are DEFINITELY things that the OP could have done/said in the room. Is there anything wrong with the OP saying, "Well, as my classmate has demonstrated, we all have our own ideas about this. But, even though my classmate brought up excellent points, I'm sure that she agrees with me that a decision of such magnitude should not be made after talking to only one or two people. The decision needs to be made after talking to many people, getting many opinions, and considering your options carefully."

Or the OP could have spoken up before his classmate really opened her mouth, and said "Well, neither of us are comfortable discussing such a serious decision with you, particularly because we are both at the very beginning of our clinical training. If you like, we will get the senior physician, who has more experience with such matters." I would even have interrupted my classmate and said, "Well, before you really get into the discussion, I think that the senior physician, who is in charge of this particular patient's care, should at least be present at such a serious discussion. Let's go get him and we'll be right back."

There are lots of ways that the OP could have handled it without unduly embarrassing his classmate.

P.S. You can dismiss PandaBear all you want, but he is right in that inter-colleague behavior transcends politics. For the record, I'm pretty strongly pro-life, and I don't agree with what the OP's classmate did. That being said, I'm not advocating that OP run to his attending and subtly rat out his colleague. That's not professional either, it's ineffective, and it's (frankly) a cop-out.

You're making quite a few assumptions about how the other student would have taken the information. Perhaps she would have learned something, perhaps not. Maybe the other student would have kept her opinions to herself if the OP chimed in, but maybe not. The OP was really on the spot and didn't have time to think of all of these alternatives. If I were the OP, I'd really rather risk having a fellow med student angry with me instead of allowing the parents to leave without hearing a more fairly balanced presentation. If all I could think of were the suggestions I posted, I'd rather do that than do nothing at all. Because the student exercised such poor judgement, I really don't think I would have taken a chance of the conversation escalating at all by interrupting her. If that student was so ignorant to think that promoting her personal beliefs (which she obviously felt strongly about) was appropriate, what else would that student consider appropriate?

Let's say that the OP did chime in and the attending came in and presented both sides. Then let's say that on a different rotation, the OP and the same student were on a different rotation together and a similar situation popped up and the other student did the same thing. Would you still not "tattle" on the other student?

In this instance, because the OP opted not to chime in while they were with the parents-to-be, how else would the OP have ensured that the parents got unbiased information if he didn't say something to the attending?

Handing the student an article on medical ethics would be providing the student the opportunity to educate herself. (I really don't see why that would be offensive).

 

[AZhopeful]

Um, why not? Should I direct them to actions that are inconsistent with my views? My guess is that you're going to say we shouldn't direct them at all, but a lot of patients want YOUR thoughts.

Exactly, Prowler. Doctors are human, and should practice as humans. Of COURSE we color our advice with our own values and beliefs, it's what we're supposed to do. To give advice w/ the total suspension of beliefs, like Good Yeast suggested, is unfounded(and impossible). Are we supposed to be walking data servers? Access Medicine or MD Consult or DynaMed relay stations? What's the point of working with other people in ANY capacity if I'm constantly suspending my beliefs to do so? We're not supposed to be mercenaries.

Panda's right. The idea that the cornerstone of Western medicine is some complete submission to 'evidence' and data is wrong. All of the evidence and knowledge in the world is meaningless without the human context.

I'm disappointed, Good Yeast. Have the endless hours of 'humanism' classes that got shoved down your throat in M1 and M2 years been for naught?🙄

A plug for a great work that I think sums up the argument of the meaninglessness of knowledge w/o the context of humanity and, more importantly, the inevitable God that created it: read Ecclesiastes. It's so much more eloquent than anything that any of us on this board could come up with(even Uncle Panda), and it's hard not to agree w/ the speaker's points.

 

[45408]

I still don't think it's offensive. The student who presented a pathetic one-sided opinion to the parents violated everything that we were taught about medical ethics.

No, it didn't. I don't remember EVERYTHING in medical ethics requiring that you inform a patient about an option that you consider horrific.

 

[futuredo32]

No, it didn't. I don't remember EVERYTHING in medical ethics requiring that you inform a patient about an option that you consider horrific.

I think that a medical student counseling potential parents of a Down's baby is a really bad idea. I don't think that opting to keep this child is a horrific idea at all. I don't think that aborting is wrong either. I think it's wrong not to give the parents all of the facts.

The choice is something for the parents to decide based on unbiased medical information. Patients look to medical professionals for education and not personal opinions. It's true that most, if not all, physicians are unable to be completely unbiased about an ethical situation, but most (should) come pretty close. The student in the OPs post didn't make any attempt to educate the parents about both sides of the issue. The student used the situation to give her opinion based on her moral beliefs, and left out a lot of relevant medical information.

I hope you do remember hearing a medical ethics lecture about giving patients unbiased information in situations like this. An exam room or a hospital bed is not the appropriate stage for any of us to preach our own personal values to patients. They can seek advice from friends, family, and clergy if they are looking for guidance on morals.

 

[futuredo32]

You're done helping this patient. Let it go. You practice medicine your way and let your colleagues practice it theirs.

Assuming the attending didn't present both sides, no one helped these parents.
The other student wasn't practicing medicine, she was pushing her values onto the patients(and if the other student was pushing abortion, my opinion would be no different than it is now).

 

[OncoCaP]

Assuming the attending didn't present both sides, no one helped these parents.
The other student wasn't practicing medicine, she was pushing her values onto the patients(and if the other student was pushing abortion, my opinion would be no different than it is now).

That depends on your definition of "help." In your very narrow, self-serving definition of "help" perhaps not. Each person brings their own perspective to medicine. Presenting all the options isn't always helpful or necessary, especially if one is personally convinced that one of the options is essentially state-sanctioned murder of an innocent child. If the U.S. legalized euthanasia of children with an IQ under, say, 80 that was causing a lot of grief for parents and had issues with behavior (lots of visits to the principal's office etc.) radical ideas and the like, a number of physicians might object to the KCN injection. This is a blunt thing to say, but it's really how many pro-lifers feel. It helps to see where people are coming from.

My own personal perspective would be that the if it bothered the OP that much, s/he should talk to the other student privately in a very respectful manner if s/he though she had a strong enough working relationship to do that. I'm a big believer in talking with people I don't agree with and trying to come to some understanding on something that bothers me a lot. However, this may be one of those issues that is simply too delicate unless the collegue really creates the impression of being able to carry on a meaningful discussion on an emotionally charged topic.

 

[bcat85]

What Lenin meant, and he was speaking about revolutionaries, not liberals, was that inside the heart of every revolutionary burns a puritanical flame that is intolerant of every idea except those consistent with his belief and that he has a policeman's zeal to stamp them out.

This is probably the best criticism of liberalism I've ever heard.

 

[futuredo32]

That depends on your definition of "help." In your very narrow, self-serving definition of "help" perhaps not. Each person brings their own perspective to medicine. Presenting all the options isn't always helpful or necessary, especially if one is personally convinced that one of the options is essentially murder.

In what way is my definition self serving? My opinion on this issue is the opinion of medical ethicists.

In a situation like this, presenting both sides IS essential. If one person is convinced that aborting a child is murder and can't present both sides, that person needs to inform the patients that her bias (based on personal morals and values instead of medical knowledge) prevents her from educating the parents of the risks and benefits of each alternative. That person then needs to direct the patients to someone capable of providing well balanced medical information.

It may be the opinion of the student that abortion is murder, but by law, abortion is legal. We're not talking about euthanasia, we're talking about abortion.

 

[OncoCaP]

In what way is my definition self serving? My opinion on this issue is the opinion of medical ethicists.

In a situation like this, presenting both sides IS essential. If one person is convinced that aborting a child is murder and can't present both sides, that person needs to inform the patients that her bias (based on personal morals and values instead of medical knowledge) prevents her from educating the parents of the risks and benefits of each alternative. That person then needs to direct the patients to someone capable of providing well balanced medical information.

It may be the opinion of the student that abortion is murder, but by law, abortion is legal. We're not talking about euthanasia, we're talking about abortion.

So if it were legal to administer KCN IV to children that were low IQ, deformed, not doing well in school ("polluting the gene pool" in the opinion of some future "benevolent" dictator), would you think it would be ok to present KCN IV as an option for a child with say, low IQ, deformed, with behavior problems to parents that are really at wits end and embarrassed about their child's representation of the family? Remember for the pro-lifer, a Down Syndrome fetus is a baby, a person with rights that are not much different from yours or mine when it comes to life.

I guess what I'm implying is that there needs to be more to the ethical argument than just whether an option is legal or not. Just because something is legal doesn't mean it's ethical. I do think that physicians should be sensitive to our patient's values, culture, and the values and culture in which we live. However, just as we would have expected prison guards at Auschwitz to object to practices that occurred there, it stands to reason that if a person, after much thoughtful and careful consideration believes that an abortion for reasons of genetic defect of the child is murder, it would compel the person to act on that value, which might include promoting a non-lethal option. To present a treatment option that one considers as murder would be unethical.

 

[Gut Shot]

So if it were legal to administer KCN IV to children that were low IQ, deformed, not doing well in school

Hmmm, what's this fallacy called, again?

 

[Gut Shot]

She said "life began at the time of interception," which is extremely controversial, but I cannot rule that as "scientifically false."

That is an opinion which cannot be scientifically ruled in or out. Your colleague has definitely fudged that one.

P.S. "Interception"?

 

[OncoCaP]

Hmmm, what's this fallacy called, again?

Either
(a) putting things in terms that the other person can relate to or
(b) Reductio ad absurdum

I meant (a). In any case, I think you will agree that just because something is legal doesn't mean it's ethical.

In a way there is a culture clash between pro-lifers and pro-choicers. Bridging the gap is usually impossible but if it were possible, it would probably require a certain amount of translation. That's what I'm doing above. I'm translating the significance of aborting a Down Syndrome fetus into terms that a pro-choicer might understand if they chose to understand where the pro-lifer was coming from.

 

[Gut Shot]

In any case, I think you will agree that just because something is legal doesn't mean it's ethical.

And I hope you will agree that just because you think something is unethical does not mean everyone else should conform to your opinion.

 

[OncoCaP]

And I hope you will agree that just because you think something is unethical does not mean everyone else should conform to your opinion.

Yes, true. However, if you think something is murder, you should not present it as an option to your patient. Although you probably did not mean your comment in this way, it interestingly points to why the OP should try to find a common ground with the collegue or not force the other student to conform to the OP's opinion in the matter rather than "reporting him/her to the authorities" or just let the matter go because it just cannot be resolved in most circumstances (nothing to be gained).

These questions get complicated quickly. I don't think that a physician has a right to act on whatever opinion they may hold. For example, if one physician thought that sterile technique was optional, I would think it would be reasonable to force the physician to obey the rule on that matter; it would be difficult to find a valid conscientious objection to something like sterile technique, of course.

 

[jdinovit]

If a patient asks for a physician's opinion, it is perfectly acceptable for the physician to give his or her opinion as long as it is stated as such. In fact, we are supposed to develop our own moral principles somewhere along the way to becoming physicians since we will be faced with many situations where moral dilemmas surface in the Hospitals and need to be ready to do what we believe is morally correct.

There is no law that states that you have to be neutral on every issue or present both sides equally. In fact, despite being favored by simple people, it is a philosophically fallacy to state that the neutral opinion is usually correct. Most of the time, one side is correct and the other side is dead wrong so it is up to the individual to decide what their opinion is. For example, do we present the neutral position on Hitler or the neutral position on 9/11? I am pro life and if any patient who is thinking of an abortion asks for my opinion of what to do I will tell them what I believe in and try to convince them to not murder their baby. Instead of hating your coleage for actually having the morals and guts to standing up for what she believes in doing a service by educating a patient, you should have instead stated your opinion to the patient instead of trying to back stab your colleague. I would have done so if a colleague stated something I didn't agree with to a patient. It is you who has a problem, not your friend.

 

[futuredo32]

Remember for the pro-lifer, a Down Syndrome fetus is a baby, a person with rights that are not much different from yours or mine when it comes to life.

My point is that it's about doing what is best for the patient and NOT the medical student. It's not about doing what fits into the med students religious beliefs, it's about doing what is best for the patient and educating the patient so the patient make a choice that is best for them. That was not done in this case. If a student's views on this issue are so strong that he/she is unable to inform the parents of all of their options he/she should needs to direct the parents to someone else. We don't know if the student had ever been educated on medical ethics in a situation like this. Did the student know that ethically she/he should have presented both sides to the parents? Or was the student so concerned about her own religious beliefs that she/he allowed them to blind her/himself ? No one was stating that the student perform the abortion if the parents chose that option, just that she present a relatively unbiased presentation of information or direct the parents to someone who could/would .

It had been suggested to medical students at the hospital where I have done most of my rotations that if we saw an attending doing something that was really different (ie wrong) than what we learned, that the appropriate way to engage our attending in a discussion was to find an article on the topic and say something like "Dr.x, I'm confused, I was reading about xyz in this article and you did abc. Would you help me to understand things here?" I think that's one reason why I liked the idea of giving the other student an article. I would hope that we would all want to learn and not let our egos get so big that we would be offended by one of our colleagues handing us an article so that we can help patients.

This discussion is getting more than a little ridiculous compaing it to Hitler 🙄 I have stated my opinion and I think I'll end my participation in this discussion now.

 

[Gut Shot]

Yes, true. However, if you think something is murder, you should not present it as an option to your patient.

Sorry, but the cat's out of the bag. Abortion is legal and the citizenry is aware of its existence.

 

[dienekes88]

Sorry, but the cat's out of the bag. Abortion is legal and the citizenry is aware of its existence.

That could be seen as a reason that the medical student did nothing wrong. The woman is already aware of her options. The medical student isn't denying her the option... just saying that abortion isn't the only option.

Furthermore, just because it's legal and known does not mean it's right. Oregon has legalized physician assisted suicide. That doesn't mean it's right.

 

[Gut Shot]

That could be seen as a reason that the medical student did nothing wrong. The woman is already aware of her options. The medical student isn't denying her the option... just saying that abortion isn't the only option.

Here is Good Yeast's description of what happened:

However, I witnessed 10 minutes of she infusing her pro-life agenda into the patient and her husband. Apparently she knows what she's talking, because she gave no false information, scientifically speaking. She said "life began at the time of interception," which is extremely controversial, but I cannot rule that as "scientifically false." She emphasized on the fact that "People with Down can be happy and adorable," which is true too. She said "sometimes in life we simply have to accept what cannot be changed by our wills," and that is in no ways wrong. She also went over the risks and complications of abortion, which were perfectly supported by the literature.

1. Stating that "life begins at the time of interception (sic)" is opinion, not scientific fact. That statement had no place in the discussion.

2. People with Down syndrome can be "happy and adorable," but it would be professionally remiss to ignore to potential negative outcomes: the likelihood that the personal would be low functioning, the risks of medical complications such as ALL and AML, the potential financial and personal stresses the family might endure, etc. The potential parents need an open, honest discussion of what the future may bring based on their current decision, not a glossing over of anything bad that may happen.

3. Abortion does carry medical risks, but they are significantly smaller than carrying a pregnancy (any pregnancy) to term. To conveniently omit this is, shall we say, less than ideal from the standpoint of medical counselling.

4. The statement "sometimes in life we simply have to accept what cannot be changed by our wills" is true, but I fail to see how this instance, where there is a clear decision that can be made, applies to that statement.

Overall Grade: F

 

[TMP-SMX]

Here is Good Yeast's description of what happened:



1. Stating that "life begins at the time of interception (sic)" is opinion, not scientific fact. That statement had no place in the discussion.

2. People with Down syndrome can be "happy and adorable," but it would be professionally remiss to ignore to potential negative outcomes: the likelihood that the personal would be low functioning, the risks of medical complications such as ALL and AML, the potential financial and personal stresses the family might endure, etc. The potential parents need an open, honest discussion of what the future may bring based on their current decision, not a glossing over of anything bad that may happen.

3. Abortion does carry medical risks, but they are significantly smaller than carrying a pregnancy (any pregnancy) to term. To conveniently omit this is, shall we say, less than ideal from the standpoint of medical counselling.

4. The statement "sometimes in life we simply have to accept what cannot be changed by our wills" is true, but I fail to see how this instance, where there is a clear decision that can be made, applies to that statement.

Overall Grade: F

I do have to say one thing though. I was thinking I was the only one that noticed "interception".

 

[gleneagles3]

Good Yeast prepare to have your mind blown…

What if in fact your “colleague” is Pro-Choice? And upon hearing that the patient was already aware of the abortion option, felt so ethically neutral that your Pro-Choice “colleague” presented the Pro-Life alternative? So in actuality they were doing a fantastic job at making sure the patient was aware of both options.

My head just exploded…

 

[bcat85]

This is what I was thinkin too. Imagine if life really began at interception... how much more exciting would monday night football be?

 

[Gut Shot]

This is what I was thinkin too. Imagine if life really began at interception... how much more exciting would monday night football be?

If life begins with interception, was Jesus conceived with an immaculate reception?

 

[8744]

In what way is my definition self serving? My opinion on this issue is the opinion of medical ethicists.

In a situation like this, presenting both sides IS essential. If one person is convinced that aborting a child is murder and can't present both sides, that person needs to inform the patients that her bias (based on personal morals and values instead of medical knowledge) prevents her from educating the parents of the risks and benefits of each alternative. That person then needs to direct the patients to someone capable of providing well balanced medical information.

It may be the opinion of the student that abortion is murder, but by law, abortion is legal. We're not talking about euthanasia, we're talking about abortion.

Suppose you work in a Catholic hospital or in a public hospital in Louisiana, both places where the discussion of abortion is forbidden; in the former by religious and the latter by secular law. Obviously you would be, by discussing abortion, violating somebody's code of ethics, in this case codes that are ratified by no less authorities than that of the Pope or the people of the State of Louisiana.

In fact, you can be fined and lose your privileges for discussing abortion in a Louisiana public hospital.

 

[8744]

My point is that it's about doing what is best for the patient and NOT the medical student. It's not about doing what fits into the med students religious beliefs, it's about doing what is best for the patient and educating the patient so the patient make a choice that is best for them. That was not done in this case. If a student's views on this issue are so strong that he/she is unable to inform the parents of all of their options he/she should needs to direct the parents to someone else. We don't know if the student had ever been educated on medical ethics in a situation like this. Did the student know that ethically she/he should have presented both sides to the parents? Or was the student so concerned about her own religious beliefs that she/he allowed them to blind her/himself ? No one was stating that the student perform the abortion if the parents chose that option, just that she present a relatively unbiased presentation of information or direct the parents to someone who could/would .

It had been suggested to medical students at the hospital where I have done most of my rotations that if we saw an attending doing something that was really different (ie wrong) than what we learned, that the appropriate way to engage our attending in a discussion was to find an article on the topic and say something like "Dr.x, I'm confused, I was reading about xyz in this article and you did abc. Would you help me to understand things here?" I think that's one reason why I liked the idea of giving the other student an article. I would hope that we would all want to learn and not let our egos get so big that we would be offended by one of our colleagues handing us an article so that we can help patients.

This discussion is getting more than a little ridiculous compaing it to Hitler 🙄 I have stated my opinion and I think I'll end my participation in this discussion now.

47 states have "conscience clauses" of one kind or another that explicitly exempt physicians from so much as referring a woman for an abortion if it is inconsistent with their moral or religious beliefs.

 

[8744]

I still don't think it's offensive. The student who presented a pathetic one-sided opinion to the parents violated everything that we were taught about medical ethics. Just telling the student that the other side should have presented would sound like my opinion and nothing more. Providing the student with an article written by medical ethicists would provide a different view. Not informing the student of the ethical violation they committed would be silently agreeing with what they did and that's something I wouldn't and couldn't do.

I don't see myself in the same position that the OP was in because attendings that I have worked with would not allow students to see patients like this without an attending present if at all. If it does happen, I'll be sure to post the outcome.😎

Oh. Kind of like the "Ethics Consult" from the hospital "Ethics Committee" whose real purpose is to minimize liability, not arrive at some beautifully crafted ethical solution that causes the cherubim and seraphim to shout for joy.

Don't be a tool. Let it go. It doesn't matter and the good opinion of your colleagues, something you will lose rapidly once you earn the reputation for toolishness, is much more important than whether a couple of patients heard only one side of a debate and may make a decision with which you disagree.

Reminds me of the cartoon where a guy is on the internet, his wife says, "Honey, it's three AM," and he says, "Yeah, but somebody is wrong."

Let's suppose you are right about everything. You can still keep your mouth shut. People tell me things all the time that are not only wrong but flat-out ridiculous and I don't feel the need to correct them. This is the key to civilized life, good feelings, and a serene existence. You are on a crusade, apparently, and you are going to exhaust yourself upon the walls of your own private Jerusalem if you don't learn how to let some things go.

 

[45408]

I think that a medical student counseling potential parents of a Down's baby is a really bad idea. I don't think that opting to keep this child is a horrific idea at all. I don't think that aborting is wrong either. I think it's wrong not to give the parents all of the facts.

I DO think it would be terribly wrong to kill a baby because it had Downs, so I would not be able to reconcile giving that as an option.

The student used the situation to give her opinion based on her moral beliefs, and left out a lot of relevant medical information.

Such as?

I hope you do remember hearing a medical ethics lecture about giving patients unbiased information in situations like this. An exam room or a hospital bed is not the appropriate stage for any of us to preach our own personal values to patients. They can seek advice from friends, family, and clergy if they are looking for guidance on morals.

I'm not standing there lecturing them on using drugs or having pre-marital sex. I'm simply omitting the concept that killing fetuses with birth defects is an acceptable option.

 

[VincentAdultman]

Nurse we need a right wing ideal infusion on this patient stat.

 

[plainfacts]

To the OP:

For now just focus on yourself until you become an attending. Then when you are an attending expose these unprofessional medical students and either make sure they start acting professionally or get them expelled from medical school.

Just play the game for the time being then when you get power use them to do the right thing.

 

[8744]

To the OP:

For now just focus on yourself until you become an attending. Then when you are an attending expose these unprofessional medical students and either make sure they start acting professionally or get them expelled from medical school.

Just play the game for the time being then when you get power use them to do the right thing.

Yeah, then he can show those uppity conservative students how tolerant he is.

 

[plainfacts]

Yeah, then he can show those uppity conservative students how tolerant he is.

Letting colleagues act unprofessional is not tolerance but negligence.

 

[8744]

Letting colleagues act unprofessional is not tolerance but negligence.

Let me give you a little bit of wisdom: Someday it may actually be necessary for your to turn in a colleague or report him to the authorities. Suppose, for example, one of your partners is embezzeling money or defrauding the government or a private insurerer. Not only are these things wrong by themselves but your silence will be taken as complicity when things finally come out as they always do. Do not "shoot your bolt" on trivial things that are nothing really but a matter of opinion. You cannot police the thoughts and action of everybody all the time and if you let your puritanical zeal for absolutism guide your life you will gain a reputation as nothing more than a two-bit snitch.

 

[plainfacts]

Let me give you a little bit of wisdom: Someday it may actually be necessary for your to turn in a colleague or report him to the authorities. Suppose, for example, one of your partners is embezzeling money or defrauding the government or a private insurerer. Not only are these things wrong by themselves but your silence will be taken as complicity when things finally come out as they always do. Do not "shoot your bolt" on trivial things that are nothing really but a matter of opinion. You cannot police the thoughts and action of everybody all the time and if you let your puritanical zeal for absolutism guide your life you will gain a reputation as nothing more than a two-bit snitch.

I agree to an extent when talking attending vs attending. But as an attending I would definitely act against an unprofessional medical student since I value the profession. Since I'd prefer if the medical system could weed out these types of doctors I would jump on the chance when they start acting unprofessionally as well.

 

[bcat85]

Let me give you a little bit of wisdom: Someday it may actually be necessary for your to turn in a colleague or report him to the authorities. Suppose, for example, one of your partners is embezzeling money or defrauding the government or a private insurerer. Not only are these things wrong by themselves but your silence will be taken as complicity when things finally come out as they always do. Do not "shoot your bolt" on trivial things that are nothing really but a matter of opinion. You cannot police the thoughts and action of everybody all the time and if you let your puritanical zeal for absolutism guide your life you will gain a reputation as nothing more than a two-bit snitch.

And, might I add... a d***head.

There is nothing "unprofessional" about giving your opinion. I could tell someone that it is my opinion that they should try to make up with their wife after a fight, but Lord, they don't have to take it. They can do whatever they want. In the whole scheme of things on this planet, do you honestly believe you will have done anyone a service by calling them unprofessional, sabotaging them, and encouraging someone to abort their child? Really?

And for the record, Plainfacts, I will quit medicine the day that a medical student gets expelled for discouraging a patient from having an abortion. No medical school on this planet would expel a student for that, and you are a tool and a half for even thinking this could happen.

 

[45408]

To the OP:

For now just focus on yourself until you become an attending. Then when you are an attending expose these unprofessional medical students and either make sure they start acting professionally or get them expelled from medical school.

Just play the game for the time being then when you get power use them to do the right thing.

Students don't get expelled from medical school for anything remotely resembling what the thread starter is describing. You'll get expelled for sneaking morphine from your patients or cheating on an exam or telling your classmates that you're planning on kidnapping a woman and child for your own personal slaves.

 

[thebeatblitz]

You should report yourself to the attending for being so passive-aggressive. If this affected you so tremendously, why didn't you acknowledge all of the crap you just rambled on about, and then simply tell the patient that abortion is still an option, and it's ultimately her choice?

Then, you two look like ethics superstars instead of bumbling idiots.