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Professionalism in Medicine
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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.
Index

Index

AAMC

See Association of American Medical Colleges (AAMC)

ABIM

See American Board of Internal Medicine

Accreditation Council on Graduate Medical Education (ACGME), 322, 435

definition of medical professionalism, 11, 233

generational conflict created by, 147

ACGME

See Accreditation Council on Graduate Medical Education

adult primary care (cases)

commitment to professional responsibilities, 397–401

honesty with patients, 230–235

improving quality of care, 309–312

patient welfare, 115–119

primary care (managing conflicts of interest case) 361–366

See adult primary care,

primary care (patient autonomy case) 154–158

See adult primary care,

advocacy for patients, 1, 10, 173–174

by advocacy expert, 252–253, 333–335

by AMA Student Association, 389

consideration as inappropriate, 60–61

by cultural competency advocate, 196–198

by health consumer advocate, 241–243

at the hospital level, 122

by lawyers, 318

by mental health advocate/patient, 174–176

by parents, 238–239

by physicians, 126, 141, 275

requirements for, 223

social justice principle and, 216, 223

by students, 76, 353

Akhtar, Salman (M.D.), 203–204, 220

Albritton, Josephine (M.D.), 240–241, 412–413

Alexandraki, Irene (M.D.), 273–276

Allen, Kiona, 66–67

altruism

challenges of integration, 30

importance of, for physicians, 93, 146

of patients towards medical students, 37

private vs. non-private services, 37, 38–39

vs. self-interest, 1, 11, 13, 42

American Academy of Pediatrics, 182

American Board of Internal Medicine (ABIM), 310, 320

contribution to professionalism, 8

definition of medical professionalism, 11

Maintenance of Certification, 321, 322

See also Physician’s Charter on Medical Professionalism

American Board of Medical Specialties (ABMS), 320, 435, 438

American Cancer Society (ACS), 159–160, 230

American College of Emergency Physicians, 140

American College of Obstetrics and Gynecology, 52, 194–195, 372

American College of Physicians-American Society of Internal Medicine, 310, 399–401

American College of Physicians Ethics Manual, 65

American College of Surgeons, 436

American Health Information Management Association, 53

American Medical Association (AMA)

Code of Ethics, 65, 97, 180–181, 207–208, 209, 274, 281, 296, 310

conflict of interest policies, 381

Council on Ethical and Judicial Affairs, 374–375

Council on Medical Education, 434–435

on cultural diversity, 197

on ethics of advertising, 371

on ethics of retainer medicine, 364

on jurors and medical negligence, 403–404

on patient autonomy, 182

American Medical Student Association, 389

American Thoracic Society, 140

Antommaria, Armand (M.D., Ph.D.), 376–377

Arizona Jury Project, 404–405

Arnold, L., 12–13, 15, 100

Association of American Medical Colleges (AAMC)

on conflict of interest, 96, 389

on cultural diversity, 197

definition of medical professionalism, 11–12

on gift giving to students, 91–92

health/mental health coverage recommendations, 74

mean educational debt data, 221

attorney perspective (cases)

commitment to professional responsibilities, 399–401, 428–430

honesty with patients, 53–54, 233–235

managing conflicts of interest, 373–375

patient welfare, 122–124, 131–133

social justice case, 209–210

Banja, John, 234

Belling, Catherine (Ph.D.), 161–163

Bellino, Paul J., III (M.D.), 167–169

beneficence, 83, 138

and consent process, 178

Hippocratic Oath as example of, 142

physician’s actions and, 274

Best, Kimberly (M.D.), 172–174

bioethicist perspective (on cases)

honesty with patients, 232–235, 246–248

improving quality of care, 342–344

patient confidentiality, 276–278

Blank, Linda L., 219–224

Bok, Sissela, 232

Branigan, Monica (M.D.), 158–161

Brent, Robert (M.D., Ph.D.), 401–403

Brigham, Timothy (M.Div, Ph.D.), 408–411

Brincat, Cynthia (M.D., Ph.D.), 194–196, 218

Brucker, Paul (M.D.), 230–233

California Supreme Court, 302

Canadian College of Family Practice, 435

cardiology (social justice) case

cardiologist perspective, 189–192

sociologist perspective, 192–193

care gaps (in lipid management), 313

Caruso, John (M.D.), 163–165

Cassel, Christine K., 320–323

Center for Medical Consumers, 242

Cheng, T.L., 297

Christie, Christopher (U.S. Attorney), 382

clinical rotations

disclosures to patients issue, 50–51

as “initiation” for life-death decisions, 29

patient hesitancy, 34–35

race to learn procedures, 50

student preceptor choice and, 79

Code of Ethics (AMA), 65, 97, 180–181, 207–208, 209, 274, 281, 296, 310

Code of Ethics for Nurses, 294–295

Code of Professional Conduct (American College of Obstetrics and Gynecology), 194–195

Coffin, Susan (M.D., M.P.H.), 69

Cohn, Herbert (M.D.), 416–419

commitment to a just distribution of finite resources (cases), 78–84

commitment to professional responsibilities (cases)

adult primary care, 397–401

emergency medicine, 425–430

neurology, 421–425

pediatrics, 401–405

psychiatry, 411–415

pulmonary medicine, 406–411

student and faculty cases, 43–46, 96–99

surgery, 416–421

commitment to scientific knowledge (case), 84–90

complementary/alternative medicine (CAM) physician recommendation (case), 87–90

conflict resolution strategy, 138

conflicts of interest (also see managing Conflicts of Interest)

associations/organizations monitoring, 389

financial

background information, 385–387

in human subjects research, 387–388, 390–391

in medical education, 388–389, 391–392

consumer driven healthcare, 118

Cooke, Molly (M.D.), 30–31

Coronary Artery Surgery Study (CASS), 190

Coulehan, Jack (M.D., M.P.H.), 397–399

Council on Ethical and Judicial Affairs (AMA), 374–375

Council on Medical Education (AMA), 434–435

covenant approach to professionalism, 14

credentialing (accreditation) of institutions and programs

hospitals, 436

individuals

certification, 437–438

licensure, 436–437

recertification, 438–439

relicensure/revalidation, 437

medical schools, 434–435

postgraduate training programs, 435–436

and professionalism, 432–434

Crossing the Quality Chasm (IOM), 320

Cruess, Richard and Sylvia, 12, 15–16

Dana, Jason (Ph.D.), 369–371

Dartmouth Atlas of Health Care (2008 report), 82

deception and lying, 254–255

decision-making

BMJ’s Clinical Evidence on, 89–90

ECT recommendation (case), 129

end of life, 81–82

end of life care, 81–84

by minors, 168

oncology (case), 158–163

paternalism (old) model, 138

patient autonomy and, 178–179

by surrogates, 179

U.S. Preventive Services Task Force guidelines, 157

Declaration of Geneva, 294

defensive medicine, 79, 257

definitions/descriptions of medical professionalism

AAMC, 11–12

AAMC and NBME, 12

ABIM, 11

ACGME, 11

Arnold and Stern, 12–13, 15

Cruess, Cruess, and Johnston, 12, 15

didactic descriptions, 17

differences in/themes common to, 13–15

“new professionalism” movement, 12, 31

social scientists, 11

teachers, clinicians, learners, 11

DeJong, Allan, 303

Department of Health and Human Services (U.S.), 197

Difference Principle (Rawls), 217, 224

“do no harm” principle

See nonmaleficence (“do no harm” principle)

doctor-patient confidentiality, 292, 296

doctor-patient relationships, 135, 173, 220, 292–293, 294

as building block of health care system, 204

care to maintain confidentiality, 63, 276

honesty as cornerstone of, 254

and medical error disclosure, 264

need for building trust, 160

and patient deception, 260–261

shared responsibility for care, 231

and social justice, 148

Society of Hospital Medicine dialogue guidelines, 327

Doghramji, Karl (M.D.), 286–289, 298

Donohue, Martin (M.D.), 364–367

Dorsey, E. Ray (M.D., M.B.A.), 421–423

drug abuse, 98

Duff, Patrick (M.D.), 278–280

duty hour reduction (DHR), resident mandate, 30

Eanes, Kevin, 221

Eaton, Molly (medical student), 25–26

Eddy, David, 338

education

See medical education

Edwards, Karen (M.D.), 282–285, 303

elderly patients (cases)

commitment to just distribution of finite resources, 81–84

improving the quality of care, 66–69

patient autonomy, 31–33

patient welfare/psychiatry, 128–133

electronic medical record system (EMR), 231, 234

emergency medicine (commitment to professional responsibilities case), 425–430

emergency medicine (improving quality of care case), 339–344

emergency medicine (patient welfare case), 137–141

endocrinology (improving quality of care) case, 320–325

Ethics Manual (American College of Physicians), 65, 399–401

European Federation of Internal Medicine, 310, 385

evidence-based medicine (EBM)

challenges of, 47

mindset needed for, 88

student utilization strategy, 43

USPSTF screening recommendations, 84–85, 86, 181

Faden, R., 218–219

Fader, Henry C., 428–430

False Claims Act, 365

families (cases)

commitment to just distribution of finite resources, 81–84

maintaining appropriate relations with patients, 61

patient autonomy, 163–167

patient welfare, 128–133

student advice to own, 63–66

Farah, Anthony (medical student), 36–37

Federal Patient Self-Determination Act (1991), 184

Federation of State Medical Boards, 399–401

Feldman, Arthur (M.D.), 315–318

feminization of medicine, 30

financial conflicts of interest

background information, 385–387

in human subjects research, 387–388

“first do no harm” principle, 200–202, 289

first year students

commitment to professional responsibilities, 43–46

improving access to care (case), 72–73

patient confidentiality case, 56

patient welfare case, 25–28

Flexner, A., 8

Flexner Report, 434–435

Fortier, Julia Puebla, 196–198, 218

Free Medicine Foundation, 214

Fryer-Edwards, Kelly (ethicist), 156–158

Galante, Jorge (M.D., DMSc), 379–381

Gallagher, Thomas H. (M.D.), 249–251

Garcia, David (M.D.), 325–328

gastroenterology (improving quality of care case), 315–318

Scenario, 315

general internal medicine (managing conflict of interest case), 367–371

general internist perspective (cases), 115–117

General Medical Council (United Kingdom), 400, 435, 437

Golinkoff, Michael, 238–239

Goodman, Kenneth W., 298, 302

Gorman, Bridget K., 221

Gould, Meghan (medical student), 28–30

grades (of students) issues, 43–46

Great Britain, 8

Gregory, John, 145, 296

Haddad, Amy M. (Ph.D.), 414–415

hand cleaning (case), 66–69

health care fraud

See misrepresentations

health information technology (HIT) interventions, 314

Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule, 132, 280–281, 290, 294, 298–300

Health Savings Accounts (HSAs), 118

Hendrickson, M. A., 145

Hickson, Gerald B., 252–253

Hippocratic Oath, 100, 142, 397–398

and doctor-patient confidentiality, 276, 289, 292, 294, 296

as example of beneficence, 142

Physician Charter vs., 143–144

Hobbes, Thomas, 142

honesty

breaking bad news to patients, 258

clinical situation challenges to, 260–261

deception and lying, 254–255

disclosing medical errors to patients, 258–259

between doctors-patients, importance of, 254

ethical perspectives, 255–256

historical perspectives, 256–257

informed consent

See informed consent

medical errors, 264–266

nondisclosure issue, 261–262

revealing level of training, 259

trainees and procedures, 262–263

honesty with patients (cases)

adult primary care, 230–235

neurology, 248–253

pediatrics, 235–239

psychiatry, 240–243

student & faculty case, 49–51

surgery, 243–248

hospital medicine (improving quality of care case), 325–329

human subjects research, and financial conflict, 387–388, 389–391

improving access to care (student & faculty cases), 72–78

improving quality of care (cases)

adult primary care, 315

emergency medicine, 339–344

endocrinology, 320–325

gastroenterology, 315–320

hospital medicine, 325–329

obstetrics-gynecology, 329–335

psychiatry, 335–339

student and faculty case, 66–69

Indman, Paul D. (M.D.), 371–373

infectious disease (patient confidentiality case)

bioethicist perspective, 276–278

general internist perspective, 273–275

Infectious Diseases Society of America, 140

informed consent, 79, 93

bioethics perspective, 246–248

described, 263–264

disclosure by physician, 129, 155, 240, 247, 277

minors and, 182, 390

patient autonomy and, 164

principles of, 34

process of securing, 178

as process vs. moment, 247

transparency and, 257

Institute of Medicine (IOM), 201, 234, 320, 334

intensive care unit (ICU), missions of, 83–84

International Code of Medical Ethics, 294

Inui, Thomas, 201

Isenberg, Gerald (M.D.), 206–208

Jaffe v. Redmond court case, 290

Jensen, Kathy, 378–379

Just Society concept (Rawls), 216–217

Kalet, Adina (M.D., M.P.H.), 333–335

Karras, David J. (M.D.), 339–342

King, Peter (medical student), 34–35

Kramer, Elizabeth, 238–239

Kremens, Daniel (M.D., J.D.), 210–213

LaGrelius, Thomas W. (M.D., FAAFP), 361–364

Laine, Christine (M.D., M.P.H.), 309–312

Lambert, David (M.D.), 154–156, 181

Latham, Stephen (J.D., Ph.D.), 373–375

legal liability of physicians, 126

Liaison Committee on Medical Education (LCME), 435

Liaison Committee on Medical Education (standard IS-I4-A), 218

licensure of physicians

See credentialing (accreditation) of institutions and programs

Locke, John, 142

Lopez, Bernard (M.D.), 426–428

Lown, Beth A. (M.D.), 333–335

Ludmerer, Kenneth M. (M.D.), 323–325

Lyerly, Anne Drapkin (M.D., M.A.), 330–332

MacRae, Dianne, 416–419

maintaining appropriate relationships with patients (case), 60–66, 397–401

malpractice issues

See medical malpractice issues

managing conflicts of interest (cases)

general internal medicine, 367–371

obstetrics and gynecology, 371–375

orthopedic surgery, 379–384

pediatrics, 375–379

primary care, 361–367

student and faculty cases, 90–96

Mann, Barry D. (M.D.), 243–246

Mattoon, Peter, 318

McFadden, Robert F. (M.D.), 26–28

McNett, William G. (M.D.), 31–33

medical education

assignment completion issue, 32–33

conflicts of interest in, 388–389, 391–392

evidence-based, for professionalism, 16

Flexner’s reform efforts, 8

gleaning ethical meaning, 3

professionalism curriculum, 1–2, 12, 16

web-based workbook, 16

See also Accreditation Council on Graduate Medical Education, Association of American Medical Colleges, cases student and faculty, National Board of Medical Examiners

medical malpractice issues, 52–54, 207–208, 209–210, 232, 257, 319, 403

“medical necessity,” variation in meaning, 123

medical negligence, 403–404

apologies and, 341

Arizona Jury Project, 404–405

evaluation by doctors, 403

jurors and, 403–404

no-fault system alternative, 232

tort reform and, 209–210

medical profession

collective responsibility principles, 10

government/private sector control of, 143

increasing diversity within, 144–145

Middle Age origins, 142

paternalistic vs. patient-centered approach, 46, 160

social justice principle, 42

medical professionalism

altruism as essence of, 11

challenges of, 17

credentialing and, 432–434

definitions/descriptions of medical professionalism

AAMC, 11–12

AAMC and NBME, 12

ABIM, 11

ACGME, 11

Arnold and Stern, 12–13, 15

Cruess, Cruess, and Johnston, 12, 15

didactic descriptions, 17

differences in/themes common to, 13–15

“new professionalism” movement, 12, 31

social scientists, 11

teachers, clinicians, learners, 11

development/nurturing of, 16–18

healers embrace of, 8

increasing importance of, 7–9

medical schools teaching approach, 16

principles of, 17

senior resident as teachers of, 79

Meier, Brad (Ph.D.), 423–425

Mendel, Kenneth (M.D.), 206–208

Mental Health Act of Pennsylvania, 182

Meyer, Elaine C. (Ph.D., R.N.), 169–171

Miller, Robin (M.D.), 235–238

minors and decision-making, 168

Mirza, Sohail K. (M.D., M.P.H.), 379–384

misrepresentations, of patient history, 100, 119

Mitchell, Stephen Ray (M.D., FACP), 367–369

Morris, John (M.S.W.), 337–339

Murray, Jock (M.D., FRCP(C), MACP), 292–294

Napoli, Maryann, 241–243

Nasca, Thomas J. (M.D.), 38–40, 219–224

Nathaniel, Alvita (RN, CS, FNP), 294–296

National Board of Medical Examiners (NBME) 12

National Standards for Culturally and Linguistically Appropriate Services (CLAS), 197

negligence

See medical negligence

nephrology (patient autonomy case), 163–165

neurology (commitment to professional responsibilities case), 421–425

neurology (honesty with patients case), 248–253

neurology (patient confidentiality case), 292–296

neurology (social justice case), 210–215

No Free Lunch organization, 389

nonmaleficence (“do no harm” principle), 83, 133–134, 138, 148–149, 176, 178, 200–202, 274, 289

O’Brien, Sarah (mental health advocate), 174–176

obstetrics & gynecology (improving quality of care case), 329–335

obstetrics & gynecology (managing conflicts of interest case), 371–375

obstetrics & gynecology (patient confidentiality case), 278–282

obstetrics & gynecology (patient welfare case), 119–124

obstetrics & gynecology (social justice case), 193–198

oncology (patient autonomy case), 158–163

Osler, William, 8, 137

Parsi, Kayhan (J.D., Ph.D.), 233–235

paternalism model, of decision-making, 138

patient autonomy

AMA on, 182

decision-making and, 178–179

enhanced autonomy (Quill and Brody), 177–178

ethicist perspective on, 156–158, 160–161, 165–167

faculty perspective/CAM case, 89–90

family involvement, 132

independent choice model (Schneider), 177

informed consent and, 164

occurrence of dilemmas, 179

optional model (Schneider), 177

paternalistic vs. patient-centered approach, 46, 160

patients as persons vs. respect for, 15

Physician Charter on, 177, 179

physician responsibility towards, 131

as pillar of professionalism, 9, 78

professionalism considerations, 155, 159–160, 163–165, 168–169, 172–174

See also Code of Ethics (AMA), Federal Patient Self-Determination Act (1991), informed consent

patient autonomy cases

nephrology, 163–167

oncology, 158–163, 183

pediatrics, 167–171, 182

primary care, 154–158, 181–182

psychiatry, 172–176, 182–183

student and faculty, 31–33

patient confidentiality

adolescent issues, 303

as ancient duties of physicians, 59

duty to report vs., 126

exceptions to, 302–303

legal obligations for maintaining, 55

medical student concerns about, 27

medical student issues, 301–302

need for safeguarding, 9–10, 297–298

PHI and breaches in, 298

process of teaching students, 56

patient confidentiality (cases)

access to information (3rd year students), 57–60

challenges to maintaining, 298–300

infectious disease, 273–277

neurology, 292–296

obstetrics-gynecology, 278–282, 335

pediatrics, 282–286

psychiatry, 286–294

student and faculty, 54–57

patient welfare, primacy of, 141–145

basis of, 142

Physician Charter on, 145–146

as pillar of professionalism, 78, 141

self-interest/altruism vs., 13

social contract concept, 142, 147

See also patient welfare cases

patient welfare cases

adult primary care, 115–119, 145

emergency medicine, 137–141

obstetrics & gynecology, 119–124, 145

pediatrics, 124–128

psychiatry, 128–133

student & faculty, 25–28

surgery, 133–136

patients

altruism of, towards students, 37

expectations of, 9, 36

hesitancy toward medical students, 34–35, 49

private vs. non-private, 37, 38–39

pediatrics (commitment to professional responsibilities case), 401–405

pediatrics (honesty with patients case), 49–51, 235–239

pediatrics (managing conflicts of interest case), 375–379

pediatrics (patient autonomy case), 167–171

pediatrics (patient confidentiality case), 282–286

pediatrics (patient welfare case), 124–128

pediatrics (social justice case), 198–202

Pennsylvania Health Law Project, 123

Peterson, Kathleen Flynn, 209–210

PHI

See Protected Health Information (PHI)

physicians

AIDS disclosure by (case), 133–136

baby boomer physicians, 147

certification of, 437–438

changing behavior of, 313–314

collegiality of, 440–441

disciplining of, 439–440

dual roles of, 142

fiduciary relationship with patients, 145

legal liability of, 126

licensure of, 436–437

licensure/revalidation, 437

preventive health practices of, 25–26

privacy rule of, 274

recertification of, 438–439

relicensure/revalidation, 437

role-modeling to students, 86–87

societal expectations of, 142

transparency of thinking, 157

treatment of own families, 61

Physician’s Charter on Medical Professionalism

challenges noted by, 8

on collegiality, 440–441

commitments stated by, 321

confidentiality component, 296–297

Hippocratic Oath vs., 143–144

opening statement of, 13

on patient autonomy, 177, 179

preamble to, 78, 430–431

on primacy of patient welfare, 145–146

primary commitment to patients, 275

principles of, 9, 10, 385

on professionalism, 7, 13, 431–432

social contract concept, 143, 431

Swick’s interpretations of, 13, 14

on team medicine, 441

Physician’s Desk Reference, 242

Pichert, James W. (Ph.D.), 252–253

Plumb, James, 218

PORT (Pneumonia Patient Outcomes Research Team), 137, 139–140

Powers, M., 218–219

Prayer of Maimonides, 95

Pringle, Kimmie, 218

privacy rule, of physicians, 274

private services vs. non-private services, 37, 38–39

Protected Health Information (PHI), 298

Prouty, Carolyn D. (D.V.M.), 249–251

psychiatry (honesty with patients case), 240–243

psychiatry (improving quality of care case), 335–339

psychiatry (patient autonomy case), 172–176

psychiatry (patient confidentiality case), 286–292

psychiatry (patient welfare case), 128–133

psychiatry (social justice case), 203–206

pulmonary medicine (commitment to professional responsibilities case), 406–411

quality of care (background)

clinical quality measures, 346

patient safety, 346–347

population health indices, 345–346

quality of patient’s experience, 347–348

strategies for improvement

education, 348–349

individual interventions, 349

organizational interventions, 349–350

patient-centered care, 351

peer delivery, 353–354

population health, 354

self-care, 351–352

subordinate delivery, 353

superior delivery, 353

Quill, T. E., 177–178

Rabinowitz, Howard K., 221

Radu, Andrew (medical student), 31–32

Rattner, Susan L. (M.D., MS), 180–185

Rawls, John, 216–217, 218

recordkeeping standards, 53

Redmond, Jaffe v. (court case), 290

regulatory processes, requiring physician involvement, 432–434

See also credentialing (accreditation) of institutions and programs

Reichwein, Susan (BASW), 213–215

relicensure and revalidation

See credentialing (accreditation) of institutions and programs

Rice,B., 52

Rousseau, 142

Royal College of Physicians and Surgeons (Canada), 435, 438

Sade, Robert (M.D.), 35–36, 181

Sankar, Pamelar (Ph.D.), 246–248

Schneider, Carl

mandatory model (patient autonomy), 177

optional model (patient autonomy), 177

second-line drug therapy, 118

second year students

patient autonomy case, 31–33

social justice case, 36–40

self-interest

moving beyond, to accountability, 97

vs. altruism (needs of others), 1, 11, 13, 42

self-regulation of medicine, in Western world, 434

sexual misconduct by physicians, 399–401

Shaw, George Bernard, 439

Simon, Steven R. (M.D., M.P.H.), 312–315

sleep loss issues, of students, 29, 146

Smith, C., 147

Snow, Olympia, 221

Snyder, Lois (J.D.), 180–185

Sobel, Richard (Ph.D.), 289–292, 298

social contract concept, 142, 147, 431

social justice, 9, 78

definition (conceptual), 215–216

historical background, 215

Just Society concept (Rawls), 216–217

medical practice application, 216

and professionalism/individual physicians, 221

Social Justice: The Moral Foundations of Public Health and Health Policy (Powers & Faden), 218–219

social justice cases

cardiology, 189

neurology, 210–215

obstetrics & gynecology, 193–198

pediatrics, 198–202

psychiatry, 203–206

student and faculty, 36–40

surgery, 206–210

Society of Hospital Medicine guidelines for doctor-patient dialogue, 327

sociologist perspective, equality in patient care case, 192–193

Solzhenitsyn, Alexander, 189

South-Paul, Jeanette E., 202

Spandorfer, John (M.D.), 115–118

specialty choice by students (case study)

faculty perspective, 41–43

scenario, 40

student perspective, 40–41

Starr, Paul, 142–143

step therapy, 118

Stern, D.T., 12–13, 15, 44, 97

stress-management for students, 26

student and faculty cases

commitment to a just distribution of finite resources, 78–84

commitment to professional responsibilities, 43–48, 96–102

commitment to scientific knowledge, 84–90

conflicts of interest, management of, 90–96

honesty with patients, 49–51, 52–54

improving access to care, 72–78

improving quality of care, 66–72

maintaining appropriate relations with patients, 60–66

patient autonomy, 31–33, 34–36

patient confidentiality, 54–60

patient welfare, 25–31

social justice, 36–43

student perspective (on cases)

commitment to professional responsibilities, 43–44, 46–47, 97–98, 100–101

commitment to scientific knowledge, 84–86, 88–89

conflicts of interest management, 91–92, 93–94

end of life decisions, 81–82

honesty with patients, 49–50, 52–53

improving access to care, 72–73, 75–76

improving quality of care, 66–67, 69–70

maintaining appropriate relations with patients, 60–61

patient autonomy, 31–32, 34–35

patient confidentiality, 54–56

patient welfare, 25–26, 28–30

social justice, 36–37

specialty choice, 40–41

students

AAMC health/mental health coverage recommendation, 74

advocacy for patients, 60–61, 76

debt/self-perceptions, 73

ethical dilemmas/decision-making, 29, 37

limited/developing competency of, 59

psychological distress/sleep loss issues, 29

role-modeling by faculty, 86–87

role of, 60

self-worth issue, 32

stress-management options, 26

treatment of parents, 61–62

whistle-blowing by, 99–102

Sullivan, R. J., 439

surgery (commitment to professional responsibilities case), 416–421

surgery (honesty with patients case), 243–248

surgery (managing conflicts of interest case), 379–384

surgery (patient welfare case), 133–136

surgery (social justice case), 206–210

surrogates, decision-making by, 179

Swick, H. M., 13, 14

Sylvester, Mark, 298, 302

third year students

access to information (case), 57–60

honesty with patients case, 49–51

lack of sleep (case), 28–31

physician vs. student time with patients case, 69–72

specialty choices case, 40–43

student-run homeless shelter clinic case, 75–78

“To Err is Human” report (Institute of Medicine), 234

Tomlinson, Thomas (Ph.D.), 165–167

transference phenomenon, 288

Trotter, Griffin (M.D., Ph.D.), 342–344

Tsou, Walter (M.D., M.P.H.), 198–200, 219–220

“Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” report (IOM, 2002), 201

United Kingdom, 400, 434–435, 437, 438

United States Preventive Services Task Force (USPSTF), 84–85, 86, 181, 230

Veloski, Jon (M.S.), 285–286, 303

Vidmar, Neil (Ph.D.), 403–405

Wear, Delese (Ph.D.), 200–202, 219–220

Weitz, Howard (M.D.), 189–192, 221

White Coat Ceremony, 98

“wimp factor” (of physicians), 25

Wolpe, Paul (Ph.D.), 276–278

Women’s Ischemia Syndrome Evaluation (WISE) study, 193

World Medical Association, 291

Wright, Erin (M.D.), 198–200, 219–220

Yeo, Charles (M.D.), 416–419




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