Otolaryngologists Discuss Difficult Ethical Issues

It can be a delicate situation to deal with, pointed out Dr. Maisel, and sometimes there is the risk that a report or accusation turns out to be false. We have a group in Minnesota called Physicians Helping Physicians, because nobody trusts their own hospital. We have a remote site that will, by telephone, report back-and, if asked, will make a written report, he said.

Sensitivity Training

The second scenario was of a faculty member who has had complaints from house officers and nurses about sexual innuendos and unwanted contact, but no complaints about his professionalism with patients.

Dr. Brackmann said that he suspected this issue may be more common than the drinking problem. We recently had this occur at our hospital.…The final outcome was that he was asked to leave the staff and he did so and went to another hospital.

This is an issue that can be insidious, said Dr. Maisel. If you have a man who is sexually inappropriate with women, he is usually doing it one on one, and you’re not likely to see it when it happens, he said. This means trying to figure out how severe the problem is and how much to trust the people involved. Talking with the person and discussing boundaries can sometimes solve the problem.

Faculty at university settings often undergo gender sensitivity training, and these situations often are passed on to professionals trained to deal with these issues, Dr. Levine said. But it is important to make sure it is dealt with, either through policies or procedures at your own center, or through the use of experts in the field.

Dr. Healy described a situation in which a surgeon kept telling inappropriate jokes in the OR. After receiving complaints and establishing that the doctor did indeed do this, Dr. Healy told him that aside from the fact that it is inappropriate to make these individuals feel uncomfortable, is this what you want to teach the residents, fellows and medical students-that this is the appropriate conduct for a physician? He told the doctor that if he did it again, he would need to go elsewhere to work.

Know Your Residents

The third scenario was of a third-year resident who continually underperforms in medical judgment and surgical skills, and his contribution to discussions does not equal that of his peers.

Dr. Maisel said that it is important to know the residents, so you can determine whether there are other factors, such as family problems, that are affecting their work. Some issues can be resolved over time. On the other hand, with someone who consistently performs below average, this needs to be kept up front and documented. The resident may need to be encouraged to aim for a level of practice that is appropriate for him or her-not everyone can deal with complex cases.