Writing about a false dilemna for the ethical/professional dilemna questions

[Animebob]

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The ethical/professional dilemma questions have sort of stumped me. I was wondering about how it might seem if I write about a false dilemma. Usually, dilemmas are black or white, where there is a certain evil, but some sort of value, moral, or etc makes that evil appealing. However, a false dilemma is where it appears to be mutually exclusive but is actually not.

So my story in question is that I am busy catching up with charts as a scribe, but there is a patient who constantly comes to me with questions and needs. It gets distracting is prevents me from doing my charts quickly and efficiently. My professional responsibilities and obligations as a scribe dictate that I do my charts efficiently and of high quality, but my values are to make sure that she feels supported and heard. In the end, I realize that her neediness stems from her anxiety of being a non-English speaker and her vulnerabilities as an elderly patient, so I reassure her about the quality of care, etc, and she stops constantly coming up to m,e allowing me to do my charting.

I think it's a nice story that shows some good qualities, but it isn't a perfect dilemma, so I worry it might be perceived as not answering the prompt.

 

[polymerization]

I understood the ethical dilemma to be more about a situation where you have two or more possible responses to the situation that each carry consequences severe enough to make it hard to discern what is in the best interest of the individual(s) involved. These questions pretty much require you to "look bad" somehow. If there is an obvious or easy answer, your confusion about what to do will come across melodramatic.

From our POV as applicants, it's hard to find situations where you personally navigate an ethical dilemma because to actually have a good story, you have to be in a position of decision-making and responsibility, which is not really available to us in the roles we take on.

I can think about a few, but one of the most memorable happened when I was working in genetics. You'd think it was Jerry Springer. Mom + maternal grandfather + young patient present to the clinic for autism eval. I thought it was weird that the mother wouldn't come with the father, but I assumed they are not in the picture. Mom insists we should swab everyone and send off the assay. Sus, but the attending agrees.

Sure enough, the assay comes back after having been returned internally for confirmation. The patient, mother, and presumed father return for the results. The patient is the mother and grandfather's biological child. You heard that right.

Obviously the dilemma here is between the physician's duty to report the results of the assay truthfully and the potential impact this kind of news can have on the family. This isn't a story I'm using for obvious reasons, but I found the attending's response to be really amusing. She pretty much just straight up lied and said that the results were nonspecific but notes the constellation of developmental delays the patient presents with aligns with what we would expect from ASD. She offered resources for PT/ST/OT/ABA and gave recommendations for Head Start programs etc etc. Referred to psychiatry for ongoing management.

When I asked her how she decided, she looked at me and said she feared for her personal safety and the safety of all others involved if she was upfront with the findings.

It's been >5 years since then and I'm still shaking my head about it. To my knowledge, that family never came back to the clinic (at least within the time I was there), but it was revealing to me that, I guess, you can come into the hospital and submit yourself to a test and your doctor can just refuse to tell you what the results are, hoping you'll never ask for your patient file.

Remember how I said a requirement is to "look bad?" That's what I mean. No matter what the attending would have done, it would have been easy for someone to point fingers at her after the decision was made and judge her for making it. In her mind, she was protecting the child from being abandoned by a father that cared for her and a mother that is now saddled with the consequences of what was likely a coerced interaction with her own father. Talk about a dilemma!

 

[LizzyM]

You do have a dilemma in that you can choose to do your charting, which is your contractual obligation, and tell the patient you aren't in a position to help her (she's a time sink). Or you can help the patient and neglect your charting in which case you are a nice person who is not great at doing the job you were hired to do. Somehow you managed to thread the needle and give the patient enough attention to mollify her and yet not so much that it slowed down your charting in any measurable way... at least this is how you are telling the story.

 

[pablo213]

I understood the ethical dilemma to be more about a situation where you have two or more possible responses to the situation that each carry consequences severe enough to make it hard to discern what is in the best interest of the individual(s) involved. These questions pretty much require you to "look bad" somehow. If there is an obvious or easy answer, your confusion about what to do will come across melodramatic.

From our POV as applicants, it's hard to find situations where you personally navigate an ethical dilemma because to actually have a good story, you have to be in a position of decision-making and responsibility, which is not really available to us in the roles we take on.

I can think about a few, but one of the most memorable happened when I was working in genetics. You'd think it was Jerry Springer. Mom + maternal grandfather + young patient present to the clinic for autism eval. I thought it was weird that the mother wouldn't come with the father, but I assumed they are not in the picture. Mom insists we should swab everyone and send off the assay. Sus, but the attending agrees.

Sure enough, the assay comes back after having been returned internally for confirmation. The patient, mother, and presumed father return for the results. The patient is the mother and grandfather's biological child. You heard that right.

Obviously the dilemma here is between the physician's duty to report the results of the assay truthfully and the potential impact this kind of news can have on the family. This isn't a story I'm using for obvious reasons, but I found the attending's response to be really amusing. She pretty much just straight up lied and said that the results were nonspecific but notes the constellation of developmental delays the patient presents with aligns with what we would expect from ASD. She offered resources for PT/ST/OT/ABA and gave recommendations for Head Start programs etc etc. Referred to psychiatry for ongoing management.

When I asked her how she decided, she looked at me and said she feared for her personal safety and the safety of all others involved if she was upfront with the findings.

It's been >5 years since then and I'm still shaking my head about it. To my knowledge, that family never came back to the clinic (at least within the time I was there), but it was revealing to me that, I guess, you can come into the hospital and submit yourself to a test and your doctor can just refuse to tell you what the results are, hoping you'll never ask for your patient file.

Remember how I said a requirement is to "look bad?" That's what I mean. No matter what the attending would have done, it would have been easy for someone to point fingers at her after the decision was made and judge her for making it. In her mind, she was protecting the child from being abandoned by a father that cared for her and a mother that is now saddled with the consequences of what was likely a coerced interaction with her own father. Talk about a dilemma!

Wow crazy story... would make for a very interesting essay haha

 

[Mr.Smile12]

The ethical/professional dilemma questions have sort of stumped me. I was wondering about how it might seem if I write about a false dilemma. Usually, dilemmas are black or white, where there is a certain evil, but some sort of value, moral, or etc makes that evil appealing. However, a false dilemma is where it appears to be mutually exclusive but is actually not.

When you first learn about ethical dilemmas, they are designed to be black and white. Otherwise, you can't determine what the more ethical path is. Real life will be much more gray, but it's not a "false dilemma." That's what happens when you gain more experience and leadership roles.

I discuss this with the HPSA Situational Judgment Test workshop.