Collaborative Ethics
Last week, I tried something that I had never done before. On the first day of teaching my seminar, Practical Strategies for Engaging Physicians, after discussing ”Understanding Physician-Hospital Differences,” I asked this group of healthcare administrators, “Would you be willing to discuss the ethical issues involved in physician-hospital relations?”
When they agreed, I asked , first in small groups, then the group as a whole, to discuss the following questions:
- What ethical considerations involve physician-hospital relations
- Where does the responsibility lie in addressing these issues
- What should be our next steps
The first group took the courageous approach of looking into the mirror and saying that ethics were fundamental to transparency, which is the building block of trust. They felt that, in addition to providing care, hospital leaders needed to share information openly, not just the information that supported their viewpoints. Implicit in this approach was the imperative of tactful candor, to say no if they were unable to implement a suggestion from a physician rather than to euthanize the suggestion with ”death by the slow no.”
The second group explored approaches that they had taken to deal with financial conflicts of interest, including:
- requiring vendors to make appointments to visit the hospital, sign in at the securitydesk, and wear a badge that said “vendor” when they were on hospital premises
- abolishing “free lunches” provided by drug and device companies
- requiring off-label treatments to be approved by the Institutional Review Board
- performing random reviews of charts by a team of physicians and nurses to identify patterns of unnecessary care
The third group discussed end-of-life care. Members of this group had implemented a palliative care service and utilized a multidisciplinary end-of-life committee to discuss personal opinions in the context of providing optimal patient care. They found that the resources invested in these items brought a high return because they made families and caregivers feel that their concerns mattered.
I had been uncertain of what would result from this discussion. I was pleased not only with the insights but also with the intra-group bonds that formed from sharing personal viewpoints. Their input provided a context for subsequent teaching sessions involving active listening, medical staff integration models, and physician retention strategies.
When I asked the group, “Should a discussion of ethics be part of future seminars on physician-hospital relations,” they agreed unanimously.
What do you think?
- Have discussions of ethics come up in physician-hospital interactions where you work
- If so, what issues did you discuss
- What were the outcomes
As always, I welcome your input to improve healthcare collaboration.
Kenneth H. Cohn
© 2009, all rights reserved
Posted in Learning
Comments
Time: September 9, 2009, 2:39 pm
[...] Ken Cohn, a physician and consultant (who I know in real life [IRL]), recounts a (positive) experience in asking health care administrators to consider ethics in physician-hospital relationships. [...]
Share Your Opinions