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Professionalism in Medicine
Cambridge University Press
9780521879323 - Professionalism in Medicine - A Case-Based Guide for Medical Students - Edited by John Spandorfer, M.D., Charles A. Pohl, M.D., Susan L. Rattner, M.D., M.S. and Thomas J. Nasca, M.D.
Frontmatter/Prelims

PROFESSIONALISM IN MEDICINE: A Case-Based Guide for Medical Students

Medical professionalism is a challenging, evolving, and lifelong endeavor. Professionalism in Medicine: A Case-Based Guide for Medical Students helps begin this process by engaging students and their teachers in reflection on cases that resonate with the experiences of life in medicine. Through the book’s seventy-two cases, commentaries, videos, and literature-based reviews, students explore the many challenging areas of medical professionalism. Readers will appreciate the provocative professionalism dilemmas encountered by students in the pre-clinical years and clinical rotations and by physicians of various specialties. Each case is followed by two commentaries by writers who are involved in health care decisions related to that case, and who represent a wide variety of perspectives. Authors represent forty-six medical schools and other organizations and include physicians, medical students, medical ethicists, lawyers, psychologists, nurses, social workers, pharmacists, health care administrators, and patient advocates.

John Spandorfer, M.D., is an Associate Professor of Medicine and an Associate Dean for Education at Jefferson Medical College, and a Fellow in the American College of Physicians.

Charles A. Pohl, M.D., is a Professor of Pediatrics and an Associate Dean for Student Affairs at Jefferson Medical College, and a Fellow in the American Academy of Pediatrics.

Susan L. Rattner, M.D., is a Professor of Medicine and Family and Community Medicine and Senior Associate Dean for Academic Affairs and Undergraduate Medical Education at Jefferson Medical College, and a Fellow in the American College of Physicians.

Thomas J. Nasca, M.D., is Chief Executive Officer of the Accreditation Council for Graduate Medicine, a Professor of Medicine and formerly the Gertrude M. and Anthony F. DePalma Dean (2001–2007) at Jefferson Medical College, and a Master in the American College of Physicians.


To my son Adam, he is always with me. JS

To my friend and colleague Philip Wolfson, M.D., whose passion and commitment inspire this work. SLR

To Janice, Emma, and Annie, who serve as my role models and give us hope for a better tomorrow. CAP

To Jean and our sons, whose sacrifices made all we do possible. TJN

And to our patients, whose gift of trust is the reward of professionalism. The Editors


Professionalism in Medicine

A Case-Based Guide for Medical Students

Edited by

John Spandorfer, M.D.

Associate Professor of Medicine
Associate Dean for Education
Jefferson Medical College

Charles A. Pohl, M.D.

Professor of Pediatrics
Associate Dean for Student Affairs and Career Counseling
Jefferson Medical College

Susan L. Rattner, M.D., M.S.

Professor of Medicine
Professor of Family and Community Medicine
Senior Associate Dean for Academic Affairs and Undergraduate Medical Education
Jefferson Medical College

Thomas J. Nasca, M.D.

Chief Executive Officer Accreditation Council for Graduate Medical Education
Professor of Medicine
Jefferson Medical College


CAMBRIDGE UNIVERSITY PRESS
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Cambridge University Press
32 Avenue of the Americas, New York, NY 10013-2473, USA

www.cambridge.org
Information on this title: www.cambridge.org/9780521704922

© Cambridge University Press 2010

This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press.

First published 2010

Printed in the United States of America

A catalog record for this publication is available from the British Library.

Library of Congress Cataloging in Publication Data

Professionalism in medicine : a case-based guide for medical students / edited by John Spandorfer … [et al.].
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-521-87932-3 (hardback) – ISBN 978-0-521-70492-2 (pbk.)
1. Medicine–Vocational guidance–Case studies. 2. Medical ethics–Case studies. 3. Clinical competence–Case studies. I. Spandorfer, John. II. Title.
[DNLM: 1. Clinical Competence. 2. Physician’s Role. 3. Professional Autonomy. W 21 P9645 2009]
R690.P763 2009
610.69–dc22 2009027844

ISBN 978-0-521-87932-3 Hardback
ISBN 978-0-521-70492-2 Paperback

Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party Internet Web sites referred to in this publication and does not guarantee that any content on such Web sites is, or will remain, accurate or appropriate.Every effort has been made in preparing this book to provide accurate and up-to-date information that is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors, and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors, and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.


Contents

Contributors
vii
Acknowledgments
xv
Introduction
1
PART ONE      DEFINING MEDICAL PROFESSIONALISM
1.            Defining, Teaching, and Learning Professionalism
7
PART TWO      CASES INVOLVING MEDICAL STUDENTS
2.            Student and Faculty Cases
25
PART THREE    CASES INVOLVING PHYSICIANS
3.            Principle of Primacy of Patient Welfare
115
4.            Principle of Patient Autonomy
154
5.            Principle of Social Justice
189
6.            Commitment to Honesty with Patients
230
7.            Commitment to Patient Confidentiality
273
8.            Commitment to Improving Quality of Care
309
9.            Commitment to Maintaining Trust by Managing Conflicts of Interest
361
10.           Commitment to Professional Responsibilities
397
APPENDIX:     Cases by Specialty
453
Index
455

Contributors

David Abraham, Ph.D.

Professor of Microbiology and Immunology
Jefferson Medical college

Salman Akhtar, M.D.

Professor of Psychiatry and Human Behavior
Jefferson Medical College

Josephine Albritton, M.D.

Assistant Professor, Department of Psychiatry and Health Behavior
Medical College of Georgia

Irene Alexandraki, M.D.

Assistant Professor of Medicine
University of Florida College of Medicine-Jacksonville

Kiona Allen, M.D.

Former student, University of Pennsylvania School of Medicine

Armand Antommaria, M.D., Ph.D.

Assistant Professor of Pediatrics
University of Utah School of Medicine

Louise Arnold, Ph.D.

Professor and Associate Dean
Office of Medical Education and Research
University of Missouri–Kansas City School of Medicine

David Axelrod, M.D., J.D.

Assistant Professor of Medicine
Jefferson Medical College

Phil Barbosa, M.D.

Former student, University of Minnesota Medical School

Catherine Belling, Ph.D.

Assistant Professor of Medical Humanities and Bioethics
Northwestern University Feinberg School of Medicine

Paul J. Bellino III, M.D.

Residency Program Director, Pediatrics
Geisinger Medical Center

Sarah Bergman Lewis, M.D.

Former student, University of Washington School of Medicine

Kim Best, M.D.

Director of the Division of Psychiatric Education
Albert Einstein Medical Center

Linda Blank

Vice President, The Culliton Group
Robert G. Petersdorf Scholar (2006–2007)
Association of American Medical Colleges

Justin Brandt, M.D.

Former student, Jefferson Medical College

Monica Branigan, M.D., M.H.Sc.

Family Physician in Palliative Care
St Joseph’s Health Center

Robert Brent, M.D., Ph.D., D.Sc.

Distinguished Professor of Pediatrics, Radiology, and Pathology
Jefferson Medical College
Alfred I. duPont Hospital for Children

Timothy Brigham, M.Div., Ph.D.

Senior Vice President, Department of Education
Accreditation Council for Graduate Medical Education

Cynthia Brincat, M.D., Ph.D.

Department of Obstetrics and Gynecology
University of Michigan Health Systems

Paul Brucker, M.D.

President Emeritus
Professor of Family and Community Medicine
Thomas Jefferson University

James Buchino, M.D.

Former student, University of Louisville

Clara Callahan, M.D.

Professor of Pediatrics
Lillian H. Brent Dean for Students
Jefferson Medical College

Michael Campbell, Esq.

Villanova University School of Law

John Caruso, M.D.

Associate Professor of Medicine
Assistant Dean for Graduate Medical Education and Affiliations
Jefferson Medical College

Christine K. Cassell, M.D.

President and CEO
American Board of Internal Medicine

Susan E. Coffin, M.D., M.P.H.

Associate Professor of Pediatrics
University of Pennsylvania School of Medicine

Jordan C. Cohen, M.D.

President Emeritus
Association of American Medical Colleges
Chairman, Board of Trustees
The Arnold P. Gold Foundation

Herbert Cohn, M.D.

Professor of Surgery
Jefferson Medical College

Molly Cooke, M.D.

Professor of Medicine
Director, The Haile T. Debas Academy of Medical Educators
University of California, San Francisco School of Medicine

Jack Coulehan, M.D., M.P.H.

Professor Emeritus of Preventive Medicine
SUNY at Stony Brook

Richard L. Cruess, M.D.

Professor of Surgery
Member, Center for Medical Education
Former Dean of Medicine
McGill University

Sylvia R. Cruess, M.D.

Professor of Medicine
Member, Center for Medical Education
McGill University

Jason Dana, Ph.D.

Assistant Professor, Department of Psychology
University of Pennsylvania

Allan DeJong, M.D.

Medical Director, Children at Risk Evaluation Program
Alfred I. duPont Hospital for Children

Kristin DeSimone, M.D.

Assistant Dean, Student Affairs and Career Counseling
Jefferson Medical College

Karl Doghramji, M.D.

Professor of Psychiatry and Human Behavior
Jefferson Medical College

Martin Donohoe, M.D.

Department of Community Health
Portland State University

E. Ray Dorsey, M.D., M.B.A.

Assistant Professor of Neurology
University of Rochester Medical Center

David J. Doukas, M.D.

William Ray Moore Endowed Chair of Family Medicine and Medical Humanism
University of Louisville

Patrick Duff, M.D.

Associate Dean for Student Affairs
University of Florida College of Medicine

Kevin Eanes, M.D.

Former student, Jefferson Medical College

JoAnne Earp, Sc.D.

Professor and Interim Chair
Department of Health Behavior and Health Education
Gillings School of Global Public Health
University of North Carolina

Molly Eaton, M.D.

Former student, Jefferson Medical College

Jeffrey Ecker, M.D.

Associate Professor of Obstetrics, Gynecology, and Reproductive Biology
Harvard Medical School

Karen Edwards, M.D.

Associate Dean for Primary Care
New York Medical College

Henry C. Fader, Esq.

Health Care Services Group of Pepper Hamilton LLP

Anthony Farah

Student, Jefferson Medical College

Arthur Feldman, M.D.

Magee Professor and Chairman
Department of Medicine
Jefferson Medical College

Anna Filip, M.D.

Student editor
Former student, Jefferson Medical College

Faith Fitzgerald, M.D.

Professor of Internal Medicine
University of California, Davis School of Medicine

Laura J. Fochtmann, M.D.

Professor of Psychiatry and Behavioral Sciences
Stony Brook University School of Medicine

Julia Puebla Fortier

Director, Resources for Cross Cultural Health Care

Parry Frew, M.D.

Former student, Oregon Health and Science University

Kelly Fryer-Edwards, Ph.D.

Associate Professor
Department of Bioethics and Humanities
University of Washington School of Medicine

Jorge Galante, M.D., DMSc

Professor
Department of Orthopedic Surgery
Rush University Medical Center

Thomas H. Gallagher, M.D.

Associate Professor of Medicine
Department of Medical History & Ethics
University of Washington

David Garcia, M.D.

Associate Professor of Medicine
Department of Internal Medicine
University of New Mexico School of Medicine

Karen Glaser, Ph.D.

Associate Professor of Family and Community Medicine
Associate Professor of Psychiatry and Human Behavior
Associate Dean, Academic Affairs
Jefferson Medical College

Michael Golinkoff, Ph.D.

Bala Cynwyd, PA

Kenneth W. Goodman, Ph.D.

Professor of Medicine
Miller School of Medicine
Director, Bioethics Program
University of Miami

Stephen Gordin, M.D.

Director, Clinical Affairs
Horizon Health Care of New Jersey

Bridget K. Gorman, Ph.D.

Associate Professor, Department of Sociology
Rice University

Meghan Gould, M.D.

Former student, University of California, San Francisco School of Medicine

Neerav Goyal, M.D., M.P.H.

Former student, Jefferson Medical College

Michael Green, M.D., M.S.

Professor, Departments of Humanities and Medicine
Penn State College of Medicine

Amy M. Haddad, Ph.D.

Dr. C.C. and Mabel L. Criss Endowed Chair in the Health Sciences
Creighton University Medical Center

Frederic W. Hafferty, Ph.D.

Professor of Behavioral Sciences
University of Minnesota Medical School

Chris Henry, M.D.

Former student, Jefferson Medical College

Steven K. Herrine, M.D.

Professor of Medicine
Assistant Dean for Academic Affairs
Jefferson Medical College

Gerald B. Hickson, M.D.

Professor of Pediatrics
Vanderbilt University School of Medicine

Peter J. Hoffman, Esq.

Eckert, Seamans, Cherin and Mellott, LLC, Philadelphia, PA

Eric Holmboe, M.D.

American Board of Internal Medicine

Paul Indman, M.D.

Private Practice, Gynecology
Los Gatos, California

Gerry Isenberg, M.D.

Surgery section editor
Associate Professor of Surgery
Jefferson Medical College

Kathy Jensen

Salt Lake City, UT

John C. Kairys, M.D.

Assistant Dean for Graduate Medical Education and Affiliations
Vice Chairman for Education
Department of Surgery
Jefferson Medical College

Adina Kalet, M.D., M.P.H.

Associate Professor of Medicine and Surgery
New York University School of Medicine

Gregory C. Kane, M.D.

Professor of Medicine, Vice Chair for Education
Jefferson Medical College

Dylan Kann, M.D.

Former student, University of California, Davis School of Medicine

Lawrence Kaplan, M.D.

Professor of Medicine
Assistant Dean for Clinical Education
Temple University School of Medicine

David J. Karras, M.D.

Professor of Emergency Medicine
Temple University School of Medicine

Michael G. Kavan, M.D.

Professor of Family Medicine
Associate Dean for Student Affairs
Creighton University School of Medicine

Peter King, M.D.

Former student, Medical University of South Carolina

Elizabeth Kramer

Bala Cynwyd, PA

Daniel Kremens, M.D., J.D.

Neurology section editor
Assistant Professor of Neurology
Jefferson Medical College

Shanu Kohli Kurd, M.D.

Student editor
Former student, Jefferson Medical College

Thomas Lagrelius, M.D.

President, Society for Innovative Medical Practice Design
University of Southern California Keck School of Medicine

Christine Laine, M.D., M.P.H.

Editor
Annals of Internal Medicine

David Lambert, M.D.

Senior Associate Dean for Medical Student Education
University of Rochester School of Medicine and Dentistry

J. Lindsey Lane, M.D.

Pediatrics section editor
Associate Professor of Pediatrics
Jefferson Medical College

Stephen Latham, J.D., Ph.D.

Deputy Director, Interdisciplinary Center for Bioethics
Yale University

Jeremy Lazarus, M.D.

Clinical Professor of Psychiatry
University of Colorado Denver School of Medicine

Amanda Lerman, M.D.

Former student, Jefferson Medical College

Bernard Lopez, M.D.

Assistant Dean for Student Affairs and Career Counseling
Professor of Emergency Medicine
Jefferson Medical College

Beth A. Lown, M.D.

Assistant Professor of Medicine
Harvard Medical School

Kenneth M. Ludmerer, M.D.

Professor of Medicine
Washington University School of Medicine

Anne Drapkin Lyerly, M.D., MA

Associate Professor, Obstetrics and Gynecology
Duke University School of Medicine

Dianne MacRae

Department of Surgery
Jefferson Medical College

Barry D. Mann, M.D.

Professor of Surgery
Program Director, Lankenau Surgical Residency Program
Jefferson Medical College

Peter Mattoon, Esq.

Ballard, Spahr Andrews and Ingersoll, LLP

Andrew Matuskowitz

Student editor
Student, Jefferson Medical College

Robert McFadden, M.D.

Director, Student Personal Counseling Center
Jefferson Medical College

William McNett, M.D.

Division Chief, General Pediatrics
Jefferson Medical College

Brad Meier, Ph.D.

Delaware Psychiatric Center

Kenneth Mendel, M.D.

Clinical Associate Professor of Medicine
Temple University School of Medicine
Crozer Chester Medical Center

Elaine C. Meyer, Ph.D., R.N.

Associate Professor of Psychology
Harvard Medical School

Robin Miller, M.D.

Division of Hematology-Oncology
Alfred I. duPont Hospital for Children

Sohail K. Mirza, M.D., M.P.H.

Vice Chair and Professor
Department of Orthopedics
Dartmouth Medical School
The Dartmouth Institute for Health Policy and Clinical Practice

Stephen Ray Mitchell, M.D.

Dean for Medical Education
Georgetown School of Medicine

John A. Morris, M.S.W.

Director, Human Services Practice
The Technical Assistance Collaborative, Inc.
Professor, Department of Neuropsychiatry and Behavior Science
University of South Carolina School of Medicine

Jock Murray, M.D., M.A.C.P.

Professor Emeritus
Dalhousie University

Maryann Napoli

Associate Director
Center for Medical Consumers

David Nash, M.D., M.B.A.

Dr. Raymond C. and Doris N. Grandon Professor of Health Policy
Dean, Jefferson School of Health Policy and Population Health

Alvita Nathaniel, Ph.D., FNP-BC, FAANP

Associate Professor
Coordinator, Nurse Practitioner Track
West Virginia University School of Nursing

Elizabeth Norheim, M.D.

Former student, Jefferson Medical College

Karen Novielli, M.D.

Professor of Family and Community Medicine
Senior Associate Dean, Faculty Affairs
Jefferson Medical College

Sarah O’Brien

National Alliance on Mental Illness

Molly Osborne, M.D., Ph.D.

Professor of Medicine
Associate Dean, Student Affairs
Oregon Health and Science University

Kayhan Parsi, J.D., Ph.D.

Associate Professor of Bioethics and Health Policy
Neiswanger Institute for Bioethics and Health Policy
Stritch School of Medicine
Loyola University

Kathleen Flynn Peterson, R.N., J.D.

Past President of the American Association for Justice
Robins, Kaplan, Miller and Ciresi

James W. Pichert, Ph.D.

Professor of Medical Education and Administration
Vanderbilt University School of Medicine

James Plumb, M.D.

Professor, Department of Family and Community Medicine
Jefferson Medical College

Danielle Ku’ulei Potter, M.D.

Former student, Creighton University School of Medicine

Kimmie Pringle, M.D.

Former student, Jefferson Medical College

Carolyn D. Prouty, D.V.M.

Department of Medical History & Ethics
University of Washington

Howard Rabinowitz, M.D.

Ellen M. and Dale W. Garber Professor of Family Medicine
Director, Physician Shortage Area Program
Jefferson Medical College

Lee Rabinowitz, M.D.

Former student, Jefferson Medical College

Andrew Radu, M.D.

Former student, Jefferson Medical College

Susan Reichwein, B.A.S.W.

Program Coordinator
Parkinson’s Disease and Movement Disorder Center
University of Pennsylvania

Carol Reife, M.D.

Clinical Associate Professor of Medicine
Jefferson Medical College

Caroline Rhoads, M.D.

Associate Professor of Medicine
University of Washington

J. Adam Rindfleisch, M.D., M.Phil.

Assistant Professor, Department of Family Medicine
University of Wisconsin School of Medicine

Christine Lee Ruehl, M.D.

Former student, Penn State College of Medicine

Robert Sade, M.D.

Professor of Surgery
Director, Institute of Human Values in Health Care
Medical University of South Carolina

Pamela Sankar, Ph.D.

Associate Professor, Department of Medical Ethics
Center for Bioethics
University of Pennsylvania School of Medicine

Ira Schwartz, M.D.

Associate Professor of Family and Preventive Medicine
Associate Professor of Pediatrics
Associate Dean of Medical Education and Student Affairs
Director of Admissions
Emory University School of Medicine

H. Edward Seibert, M.D.

Assistant Residency Director
Department of Emergency Medicine
Jefferson Medical College

Steven R. Simon, M.D., M.P.H.

Associate Professor
Department of Ambulatory Care and Prevention
Harvard Medical School

Thomas G. Sinas, J.D.

Robins, Kaplan, Miller and Ciresi

Lois Snyder, J.D.

Director, Center for Ethics and Professionalism
American College of Physicians

Richard Sobel, Ph.D.

Program in Psychiatry and the Law
Harvard Medical School

Paul Sorum, M.D.

Professor of Internal Medicine and Pediatrics
Albany Medical College

Jeffrey Spike, Ph.D.

Professor and Director, Campus-Wide Ethics Program
McGovern Center for Health, Humanities and the Human Spirit
University of Texas Health Science Center

Beth Ann Swan, Ph.D., C.R.N.P.

Associate Professor and Associate Dean of the Graduate Program
Jefferson School of Nursing

Mark Sylvester, M.D.

Former student, University of Miami

George Thompson, M.D.

Associate Professor
Office of Medical Education and Research
University of Missouri–Kansas City School of Medicine

Thomas Tomlinson, Ph.D.

Professor and Director
Center for Ethics and Humanities in the Life Sciences
Michigan State University

Griffin Trotter, M.D., Ph.D.

Associate Professor
Department of Health Care Ethics
Department of Surgery, Emergency Medical Division
St. Louis University School of Medicine

Walter Tsou, M.D., M.P.H.

Past President American Public Health Association
Center for Public Health Initiatives
University of Pennsylvania

Jon Veloski, M.S.

Center for Research in Medical Education and Health Care
Jefferson Medical College

Neil Vidmar, Ph.D.

Russell M. Robinson II Professor of Law
Duke Law School
Professor of Psychology
Duke University

Stanley F. Wainapel, M.D., M.P.H.

Professor of Clinical Physical Medicine and Rehabilitation
Albert Einstein College of Medicine

Delese Wear, Ph.D.

Professor of Behavioral Sciences
Northeastern Ohio Universities College of Medicine

Howard Weitz, M.D.

Vice Chair, Department of Medicine
Professor of Medicine
Jefferson Medical College

Ben Wilfond, M.D.

Professor and Head, Division of Bioethics
Department of Pediatrics
University of Washington School of Medicine

Paul Wolpe, Ph.D.

Asa Griggs Candler Professor of Bioethics
Director of the Center for Bioethics
Emory University

Erin Wright, M.D.

Cooper University Hospital

James Wu, M.D., M.P.H.

Former student, University of Wisconsin School of Medicine

Charles Yeo, M.D.

Samuel D. Gross Professor and Chair of Surgery
Jefferson Medical College

Chris Yingling, M.D.

Former student, Jefferson Medical College




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