The Culture of Healthcare Ethics and Professionalism Lecture b This material (Comp2_Unit8b) was...

The Culture of Healthcare

Ethics and Professionalism

Lecture b

This material (Comp2_Unit8b) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number

IU24OC000015.

Ethics and Professionalism Learning Objectives

• Provide a orientation to ideas about medical ethics and professionalism (Lecture a)

• Explore the relationships among ethical ideals, professionalism, and legal duties (Lecture a, b)

• Apply the general principles of ethics and professionalism to specific topics (Lecture c, d)

• Examine ethical issues in health informatics (Lecture d)

2Health IT Workforce Curriculum Version 3.0/Spring 2012

Ethics and Professionalism Ethics, Professionalism, and Law

Lecture b

Ethical Standards andLegal Standards

• Sometimes they are the same– Example: Both law and ethics prohibit harmful surgery on a

healthy patient

• Sometimes they overlap or interact– Example of overlap: State and federal laws set standards for the

practice of medicine– Example of interaction: Failure to meet professional standards

can create legal liability (malpractice case)

• Sometimes they conflict– Example: Court orders disclosure of patient information



Lecture b

AMA Opinion

• Ethical values and legal principles are closely related• Ethical obligations typically exceed legal duties• Sometimes the law mandates unethical conduct• Generally, physicians should obey current laws and

work to change unjust laws• In rare cases, ethical responsibilities should take

priority over unjust laws • Even if a legal proceeding finds a physician to be

innocent, he or she may have acted unethically



Lecture b

Standards of Professionalism

8.4 Figure: Standards of Professionalism (CC BY-NC-SA 3.0, 2012).



Lecture b

State Medical Practice Law

• Defines the practice of medicine within the state• Establishes a state medical board• Governs testing and licensing of physicians• Specifies procedures for investigation,

enforcement, and discipline of physicians



Lecture b

State Medical Board

• The majority of the members are physicians, but should also include non-physicians

• Writes rules and regulations• Gives examinations and awards medical

licenses• Investigates complaints, holds hearings• Administers disciplinary actions• Evaluates medical education programs



Lecture b

Unprofessional Conduct

• Investigators gather information• Board determines whether unprofessional

conduct has occurred • Board imposes sanctions

– Fines– Mandatory medical education– Mandatory medical treatment– Suspension or revocation of license



Lecture b

Investigation vs. Malpractice

• State medical board investigation– Addresses physician’s responsibility to the

medical profession• Malpractice lawsuit

– Addresses physician’s liability to patient• The same act or situation may result in both

an investigation and a lawsuit



Lecture b

Four Basics of Malpractice

• Healthcare provider had a duty to the patient• Minimum standards of care were not met• The failure to meet standards of care caused

an injury• The injury resulted in damages (harm)



Lecture b

Professionalism andthe Culture of Healthcare

• Lofty goals can compete with fear of potential consequences

• Prevailing attitudes in the healthcare culture can make it difficult to uncover ethical lapses



Lecture b

The Hidden Curriculumin Medical Education

• The “culture” of a medical school can contradict formal medical ethics training

• Students learn by:– “Reading between the lines” of written institutional

policies– Observing standards used for evaluation of success– Following the money– Noticing the language an institution uses



Lecture b

How the Hidden CurriculumIs Taught

• Institutional policies– Statements about how much federal grant

money the faculty is generating tell students that attracting money to the institution is an important value

• Evaluation activities– The attributes and behaviors of those who are

promoted may be more influential than ethics statements



Lecture b

How the Hidden CurriculumIs Taught (continued)

• Resource-allocation decisions– Office space– Which programs are funded

• Institutional language about money



Lecture b

Barriers to DisclosingUnethical Behavior

• Personal motivations – Loyalty to the profession

• Institutional motivations– Fear of negative publicity associated with a scandal

• Understandings about physician behavior– Be confident and exercise independent judgment– Do not raise concerns with others



Lecture b

Whistleblowingand Healthcare Ethics

• Generally, about 6 out of 10 people who observe workplace misconduct will report it

• The percentage may be even lower in the healthcare field– Fewer than 5% of medical students in their

last weeks of training said they would report unethical behavior



Lecture b

Whistleblowing Related to the False Claim Act in 2011

Of the $3 billion recovered, $2.4 billion was related to healthcare fraud

8.5 Chart: Healthcare fraud (CC BY-NC-SA 3.0, 2012).



Lecture b

Retaliation for Whistleblowing

• About 15% of whistleblowers face retaliation • Can range from mild to severe, for example:

– Snubbed by co-workers– Verbal abuse by supervisor– Denied promotion or raises– Property damage– Physical assault



Lecture b

Protection of Whistleblowers

Federal Law Example of When It Applies

False Claims Act A false claim for payment has been made, such as Medicare fraud

Occupational Safety and Health Act

Practices that result in an unsafe workplace

Clean Air Act Practices that contribute to air pollution

Solid Waste Disposal Act Improper disposal of solid waste

8.6 Table: Protection of whilstleblowers (CC BY-NC-SA 3.0, 2012).



Lecture b

Ethics and Professionalism Summary – Lecture b

• Healthcare professionals must meet both ethical and legal standards– Sometimes these standards are the same, but not always

• The sources of legal standards for healthcare professionals include state medical practices laws and malpractice law

• The culture of healthcare includes expectations that may make it difficult to disclose illegal or unethical behavior or practices



Lecture b

Ethics and Professionalism References – Lecture b

• Aasland OG, Forde R. Impact of feeling responsible for adverse events on doctors' personal and professional lives: the importance of being open to criticism from colleagues. Qual Saf Health Care. 2005;14(1):13-17.

• American Medical Association [Internet]. 2011 [cited 2011 Dec 21]. AMA code of ethics: frequently asked questions [1 page]. Available from: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/frequently-asked-questions.page.

• Associated Press [Internet]. December 19, 2011 [cited 2011 Dec 22]. Pickler N. Justice reports record false claims recoveries [1 page]. Available from: http://finance.yahoo.com/news/Justice-reports-record-false-apf-3660225829.html?x=0.

• Bolsin S, Faunce T, Oakley J. Practical virtue ethics: healthcare whistleblowing and portable digital technology. J Med Ethics. 2005;31(10):612-618.

• Council on Ethical and Judicial Affairs, American Medical Association [Internet]. 2006 [cited 2011 Dec 21]. Code of Ethics of the American Medical Association [63 pages]. Available from: https://catalog.ama-assn.org/MEDIA/ProductCatalog/m1100080/AMA%20Code%20of%20Ethics.pdf.

• Council on Ethical and Judicial Affairs, American Medical Association [Internet]. Updated November 2006 [cited 2011 Dec 21]. Opinion E-5.05, “Confidentiality,” Amendment [4 pages]. Available from: http://www.ama-assn.org/resources/doc/code-medical-ethics/505a.pdf .



Lecture b

http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/frequently-asked-questions.page

http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/frequently-asked-questions.page

Ethics and Professionalism References – Lecture b (continued)

• Ethics Resource Center [Internet]. May 29, 2009 [cited 2011 Dec 21]. Ethics glossary [5 pages]. Available from: http://www.ethics.org/resource/ethics-glossary.

• Federation of State Medical Boards [Internet]. Updated May 2010 [cited Dec 22]. Essentials of a Modern Medical and Osteopathic Practice Act [32 pages]. 12th ed. Available from: http://www.fsmb.org/pdf/GRPOL_essentials.pdf.

• Federation of State Medical Boards [Internet]. Undated [cited 2011 Dec 22]. What is a state medical board? [2 pages]. Available from: http://www.fsmb.org/pdf/what_is_a_state_medical_board.pdf.

• Grunwald HW, Howard DS, McCabe MS, Storm CD, Rodriguez MA. Misdiagnosis: disclosing a colleague’s error. J Oncol Pract. J Oncol Pract. 2008;4(3):158-160.

• Hafferty FW. Beyond curriculum reform: confronting medicine's hidden curriculum. Acad Med. 1998;73(4):403-407.

• Office of the Whistleblower Protection Program, Occupational Safety and Health Administration, U.S. Department of Labor [Internet]. Updated December 9, 2011 [cited 2011 Dec 22]. The whistleblower protection program [1 page]. Available from: http://www.whistleblowers.gov.

• Ohio State Medical Association [Internet]. Undated [cited 2011 Dec 21]. Investigations by the State Medical Board of Ohio: answers to frequently-asked questions [2 pages]. Available from: http://www.osma.org/files/documents/tools-and-resources/medical-board-licensing-and-discipline/med-bd-investigation-brochure.pdf.



Lecture b

Ethics and Professionalism References – Lecture b (continued)

• Rhodes R, Strain JJ. Whistleblowing in academic medicine. J Med Ethics. 2004;30(1):35–39.

• University of Washington School of Medicine [Internet]. Updated 2008 [cited 2011 Dec 21]. Vincler LA. Ethics in medicine: law and medical ethics [1 page]. Available from: http://depts.washington.edu/bioethx/topics/law.html.

• Washington State Medical Association [Internet]. Updated October 2005 [cited 2011 Dec 21]. Principles of Medical Ethics and Opinions and Reports of the Judicial Council of the Washington State Medical Association [71 pages]. Available from: http://www.wsma.org/getFile.cfm?mo_fileId=587.

Charts, Tables, Figures• 8.4 Figure: Standards of Professionalism (CC BY-NC-SA 3.0, 2012).• 8.5 Chart: Healthcare fraud (CC BY-NC-SA 3.0, 2012). • 8.6 Table: Protection of whilstleblowers (CC BY-NC-SA 3.0, 2012).



Lecture b

The Culture of Healthcare Ethics and Professionalism Lecture b This material (Comp2_Unit8b) was...

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