It is appropriate to select patients who have the most urgent need for surgical therapy and whose surgery is supported adequately by the facilities and equipment on site. In this scenario, the host otolaryngologist appears to be prioritizing individuals whose disorders are lower in severity and who may be friends of the otolaryngologist. This is not coherent with the ethical principle of “social justice,” where equality and severity of need are emphasized. The mission leader should discuss this impropriety with the host physician in a very tactful manner, indicating that their mission goals require the team to prioritize patient surgery by need only. Mission leaders will have to use professional communication skills to help the host otolaryngologist understand the situation without compromising the relationship.
Explore this issue:July 2016
Ethical Treatment of Patients
It is very important for participants in medical missions to prepare themselves by studying the culture of the host country, paying special attention to customs, social norms, folkways, and interpersonal etiquette. The mission team has to remember that they are guests in the host country, and although they will strive to contribute to the improved health of the host community, their proper interaction with the patients and their families will be remembered far longer than the surgical procedures. Condescension toward staff or others at the host site is clearly inappropriate. Loud and obnoxious behavior must be avoided. Acts such as shaking hands with single women, touching patients, and asking direct questions may be out of bounds, depending on the culture.
The hallmarks of a culturally successful medical mission include treating the patients as you would in the U.S., showing compassion and understanding, paying attention to the patient by listening well, advising the patient and family of surgical options (including no surgery) and risks, and acting in all matters with integrity. Ethics and professionalism know no geographic boundaries. Additionally, all efforts must be made to obtain an informed consent, while understanding that language and translation barriers might diminish the information exchange. It is generally held that consent to treat is implied if the individual presents to the triage area for care; however, implied consent is more appropriate with medical therapy, while informed consent is typically used for more extensive care, such as surgery, where the risks are greater.
Records, whether written or digital, should be kept secure in the U.S., with copies held by the local otolaryngologist for follow-up care. If the mission team returns to the same location over time, which is recommended, then the medical records will be necessary for professional follow-up and outcomes evaluations. Patients should be required to give their verbal, head-nod, or written consent to being photographed, and they should be informed that the photographs will only be used for documenting their postoperative course, to encourage other health providers to volunteer for medical missions, or for teaching medical professionals. Most importantly, the photographs should not be placed on social media sites or otherwise used inappropriately—after all, photographs of patients, no matter what the setting, represent private health information.