Saturday, February 2, 2008

A Ridiculous use of Medical Ethics Teaching

Dr. John A. King, a 49 year old osteopathic physician who has practiced in at least nine different states, is in trouble again.

The Charleston Gazette reports that King, who has "dozens" of pending malpractice cases against him in West Virginia, is now accused of overdosing two Alabama patients with pre-surgical sedatives, putting one of them into a 26 hour coma. Since 2004 King has lost or surrendered his license in Florida, Georgia, Michigan, New Jersey, Ohio, Pennsylvania, Texas, Virgina and West Virginia. Now the Alabama Board of Medicine is trying to revoke his Alabama license.

What struck me in this gruesome story was this brief comment: "[in 2006] the Alabama board fined King $2,500 and ordered him to complete a medical ethics course..."

Mandating an ethics class was not an unusual step. Miscreants are often directed to take ethics classes. What can a board imagine this will accomplish? There are three alternative rationales - cynicism, optimism, and magic.

The cynical rationale: Ordering an ethics course is a way of appearing to do something, and a justification for not undertaking meaningful action, like removing a license, which could lead to litigation.

The optimistic rationale: The miscreant means to do the right thing. An ethics course that points the way will correct erroneous beliefs and bring about reform. This was the rationale behind 19th century penitentiaries and mental asylums - convicted criminals and the mentally ill would be reformed by contemplation of scripture.

The magical rationale: Like divine intervention, the ethics class will pierce the miscreant's evil self and bring about transformation.

I have seen situations in which physicians who received many complaints about their interactions with patients changed the trajectory of their careers after communication skill training. But in a situation like that of Dr. King, with (literally) hundreds of serious allegations against him, cynicism is the most plausible explanation for referral to ethics study as an appropriate resolution.

The serious ethical issue here is failure on the part of the medical profession to follow through on its commitment to self-regulation. "Sentencing" physicians who have committed serious breaches of responsibility to ethics courses is an insult to patients and the public.


Unknown said...

But there is one term being bandied about that truly riles me every time, and I heard it a number of times last evening. Private insurers keep talking about moving patients toward CDHPs or Consumer Directed Health Plans. CDHPs are really a euphemism -- a very positive sounding term used to cover up what they really are -- catastrophic health policies. They are called catastrophic because they are the policy of last resort, usually the only way for someone who does not get employer-provided health insurance, and is not eligible for assistance programs or Medicare, to afford health insurance.


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Jim Sabin said...

Hello Sangeetha -

Your comment raises important issues. A health system should want patients to be active in shaping their care and having their values carefully listened to. But you are right that the move towards making patients more at risk for the cost of their care isn't the same as "consumer direction." The challenge our country hasn't figured out yet is how to get us all to include the cost of care in our thinking about our own and our family's care. CDHPs will probably turn out to be an early, and imperfect, effort to do this.

Catastrophic insurance is not a bad thing in itself. Many people would choose to be protected against the huge costs that accidents and serious illness can generate but to be at risk for the cost of the rest of their care, as a way of paying significantly less in premium.

I very much agree with you about the importance of the language we use. One of the terms that has riled me ever since medical school is the phrase "the patient failed chemotherapy" that sometimes gets used when we mean the treatment failed the patient.



bob2008 said...

A physician, medical practitioner or medical doctor is a person who holds a medical degree, practices medicine, and is concerned with maintaining or restoring human health through the study, diagnosis, and treatment of disease and injury.
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Jim Sabin said...

Hi Bob -

Your definition of what a physician is and is expected to do is part of why I saw the mandated ethics class as ridiculous. The physician in question had deviated so far from the essence of responsibility that lack of education could not be seen as the problem.