Thursday, August 11, 2011

A Common Ethical Dilemma

Patricia Lindholm, MD,
2010-2011 MMA President
Forgive my absence from the blog for the last few weeks.  I have good excuses.  (1) It’s summer in Minnesota.  (2) With all the rain I am mowing the lawn in my free time.  (3) My clinic went live with electronic health records this summer.  (4)  I adopted two dogs from the Humane Society and they need a bit of training.  I am sure I can find more if need be.

I have also been following some of the blogs and social networking sites as I troll for more information and resources on physician wellbeing.  On a bittersweet note, I recently read in the Huffington Post that Dr. Lee Lipsenthal (of whom I have written earlier in this blog) has a recurrence of his cancer and has been told that is the last season of his life.  His interview is a demonstration of a remarkable ability to be fully present in life as well as fully present to others as he anticipates their grief.  His work has enriched us and will continue to do so for many years to come. 

Dr. Lipsenthal was a presenter at the inaugural program of the Osler Institute’s conference on physician wellbeing last fall in Albuquerque.  I am happy to report that the conference will be offered again in the coming year, possibly twice.  You can follow the Osler Institute on Facebook. 

Of course I am also following Dr. Kevin Pho on his site  There are many posts of interest by physicians from around the country.  One that caught my eye this week was posted by Michael Kirsch, MD and titled, “Medical ethics in the office should not be a private matter.”  It appeared the day after I attended an ethics committee meeting in our newly integrated hospital and clinic.  We discussed bringing up examples of daily ethical dilemmas faced in outpatient medicine.  Dr. Kirsch lists several such outpatient dilemmas which resonate with me.  The problem is that no sooner is the issue behind me than I forget about it and lose the opportunity to fully discuss and analyze it with colleagues.  (I suspect it is a function of middle age.)

Here is an example of an ethical dilemma I have faced many times in my practice (I paraphrase):  A patient’s family member sends a note or calls to report some private information shortly before my patient’s appointment, with instructions “not to tell” the patient about who divulged the information, but hoping I can somehow dig into the matter.  Do you tell the patient about the conversation?  I have reacted differently on different occasions.  How about you?