What Medical Students Should Learn and Doctors Should Know about Ethics and Professionalism in Medicine

Behaving in an ethical and professional manner should begin in medical school and continue uninterrupted into active practice as a physician. Understanding each other, healthcare providers and students in the medical profession and understanding the concerns and views of patients and their families is an essential requirement to make decisions which are good, in the best interest of the patient and avoid unneeded conflicts.

I have created a list of what I think are important issues and terms that students should learn and physicians should also know and consider. Many of these issues and terms I have already incorporated into threads which discuss them. (Enter the term or issue into the Search field at the top of the page to get to the thread.) Some of my visitors may come up with other issues which they feel are important for doctors to be aware of and act upon them.

As a student or as a physician we should, as we care for or attend to our patients:

1) Be aware and consider the clinical situation from the viewpoints of all the stakeholders in the medical care of the patient: medical student, intern/resident, attending physician, patient, patient’s family, nurses and hospital administration. What are the healthcare interests of each and specifically the self-interests of the healthcare providers and the families?
Each will have different interests and interact differently with each other. Also consider what are the power inequalities between the stakeholders and how would this affect communication and decision-making.

2) In medical training institutions, all participants should be made aware of ethical issues within the training hierarchy. As examples, the “hidden curriculum” (teaching by superiors of their own view of professional behavior). Another is the need for humanistic behavior such as the identification of patients by including their name and not simply their disease or room number, attention to the patient as a subject and not an object when making rounds with the need for communication with the patient, caution about group discussions in front of the patient and attention to patient modesty. In addition there should be humanistic treatment of the medical student as a colleague in the healthcare team and the prevention of medical student abuse.

3) Distinguishing between withholding life support and withdrawal of life support, killing vs letting die, patient autonomy vs physician paternalism, capacity to make medical decisions vs competency. With regard to the latter, understand how a patient’s capacity to make their own medical decision is determined and by whom.

4) Consider examples of unsatisfactory communication between physicians and their patients, patients’ families, physicians and nurses and between physicians themselves which could lead to misunderstanding and conflict.
Students and physicians should also be alert to and identify “mixed messages” sent by consultants (consultants each giving conflicting prognoses) to the patient or the family.

5) All stakeholders including patients and their families should be able to distinguish between a Living Will, Advance Directive, Durable Power of Attorney for Healthcare and in states where it is law POLST (physicians Order regarding Life Sustaining Treatment).

6) All stakeholders should understand the role of the hospital ethics committee including what the committee can do and what the committee shouldn’t do.

7) All stakeholders but particularly students and healthcare providers should be watching to pickup instances which would suggest that a pro-active request for clinical ethics consultation would be appropriate instead of waiting until the management course leads to a climatic conflict.

These are my suggestions for the education of medical students and education or re-education of physicians as they move up to training ladder to and including full and independent practice of medicine. Obviously, there is much more including physician relationships to pharmaceutical companies, clinical research on patient-subjects and the ethics of "bedside rationing" and utilization of scarce resources. And as I stated, my visitors having experience as patients or families of patients may have other important issues that need the attention of students and physicians to ensure the best in ethical behavior and professionalism. ..Maurice.