Otolaryngologists Discuss Difficult Ethical Issues

It is important to evaluate and assess the [resident]’s sense of moral ethics and responsibility to take care of patients.…Make sure they are introspective enough to know their abilities and don’t go beyond that, Dr. Brackmann said.

Competency is a big issue these days, said Dr. Healy. In fact, the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Medical Specialties (ABMS) may be adding an additional competency for surgical disciplines-technical skill. We have to start looking more at competency-based education, he said.

Disagreeing with the Referring Physician

A fourth scenario presented asked what the specialist does when he or she is sent a patient by referral who has been treated incorrectly by the referring physician. Here, panelists discussed the awkwardness of approaching the doctor in question to discuss the issue.

Many can be educated by simply talking to them about the diagnosis, and how the patient should best be treated, said Dr. Maisel. This should be done by talking to them, not by sending a letter (which might not go into enough detail). But, once in a while, you’re faced with a physician who doesn’t see that he or she did something wrong. Generally, you need to communicate with the doctor, and document that you’ve done so, partly for potential legal reasons, but also to help ensure that patients get the best care. Other panelists agreed that the discussion should have a polite tone and maintain a high level of professionalism.

Dr. Healy said that he calls referring physicians regardless of whether the other doctor has done things correctly or not-to discuss the case and his own findings, and provide education where it is needed.

Related to this was the fifth scenario: A physician has recently moved to your state after having been dismissed from an academic department in another state. You start receiving numerous referrals from other physicians of patients who were inappropriately managed by this person.

Panelists concurred that this case is different from the previous scenario, because the physician in the previous scenario could likely be educated. However, in this case, a one-on-one dialogue might not work. We would report them for an investigation by the Board of Medical Quality Assurance, said Dr. Brackmann.

The Question of Professionalism

The sixth scenario discussed was of a director of a medical group who receives reports from the operating room of disruptive behavior by a colleague, including disparaging statements towards the staff and throwing of instruments.