Physician Wearing Two Hats and Patient's Best Interest (2)
Another important example of the kind of potential conflict of interest which can occur is written by Steven H. Berger, M.D. in the Psychiatric Times June 1998 Vol. XV Issue 6. It deals with the issue of ethics in forensic psychiatry. This excerpt describes the situations in which the conflict can occur.
"Dual agency also occurs when: 1) A company psychiatrist owes a treatment duty to his patient-an employee of the same company-and a simultaneous obligation to the company to return the patient to work immediately; 2) a military psychiatrist owes a treatment duty to his enlisted patient and a simultaneous duty to the military to maintain security; 3) a jail psychiatrist owes a treatment duty to his inmate patient (who is awaiting his trial) and a simultaneous duty to the state to get a confession from the inmate; 4) a state-employed psychiatrist owes a duty to the best interest of his death row patient and a simultaneous job assignment to get the execution done. Clearly, the two roles of the psychiatrist in these examples conflict with each other."
To read more about this example of a physician wearing "two hats" go to this link to read the entire article
..Maurice.
posted by Maurice Bernstein, M.D. @ 9:19:00 AM
4 comments
4 Comments:
Medical education also provides some interesting situations where the "two hat" phenomenon can be problematic. A number of medical schools have affiliations with community hospitals or other health care entities which are not otherwise owned or operated by the school. Physicians who are part of these community entities may hold faculty appointments at the college, and in some cases may have other responsibilities to the medical school, such as administrative positions. What happens when these two roles collide?
As an example, what happens when a public medical school has student-only space in a community hospital? Many hospitals apply filtering systems to their Internet access or have restrictions on what can be posted publicly in hospital space. However, a public medical school is obligated generally to follow freedom of expression rights. How can a single individual who may be employed by the community entity but hold an administrative position within the medical school effectively manage this type of situation?
I don't have a good answer. But it's troubling, nonetheless.
Dipesh, the "two hat" issue unfortunately pertains to virtually all physicians which is almost impossible to avoid: the personal, family life and their responsibilities vs the professional responsibilities to the patient. Actually, this conflict may be one which occurs more often and is potentially the most disruptive to the psyche of the physician. ..Maurice.
Indeed, it's impossible to avoid certain types of conflicts. I would argue, however, that there is perhaps a qualitative difference between the conflict inherent in duty to one's family vs patient responsibility versus what amounts to a "two employer" situation, where the two employers (in my example, a medical school and a private health care facility). The first is a conflict of different roles (family member vs health care provider), whereas the second is a conflict of different requirements of similar roles (i.e. you're in these roles, presumably, because of your professional standing.)
I'm not sure anyone can truly state they have absolutely no conflicts of interest, since everyone has personal interests and obligations -- hence a conflict between a family obligation and responsibility to a patient is almost inevitable. However, a situation where one is "serving two masters" is more avoidable. (Perhaps not easily, but I digress...) I think it once again comes down to the _recognition_ of these conflicts and prompt resolution of the issue -- preferably by the individuals themselves to avoid any potential adversarial encounters.
None of this is news to anyone, I'm sure, but it's a conflict that I don't often see commented upon.
I agree that conflict of interest related to “serving two masters” can be potentially avoidable (don’t join two systems which don’t have common goals, values or systemic procedures) as compared with conflict associated with personal vs. professional life that is completely unavoidable. On the other hand, the professional may have a better chance of managing or mediating the latter as compared with the former. This is because the professional is not in charge with “serving two masters” otherwise he/she would be the “master”. The individual will have more ability to manipulate a home life schedule. In either situation, to be a professional is to insure that the patient, about whom the professional is entrusted, receives beneficent attention. ..Maurice.
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