H.C. Ethics Week 4

This week my boyfriend had a knee surgery, so I wanted to wait until it was over so I could write about it on my blog. My boyfriend had a torn muscle in his knee, his surgery was to repair the muscle and remove scar tissue and build up associated from the injury. His surgery took place in an ambulatory surgery center. We were scheduled to be there at 7:45am. We were in the car on the way home by 11:00am. The surgery itself was about an hour. The facility was easy to walk around in, lots of signs directing the patients and visitors where to go. The employees at the facility were very friendly, informative and caring. I was very pleased with the way I was treated as well as my boyfriend. When discharged we received detailed directions on how to care of the injury, we also received a follow up phone call to check in. Although I do not have many experiences at a health care facility to compare this one to, I believe the service was excellent and my boyfriend and I are satisfied with the outcome. I did encounter one ethical situation. When the doctor finished surgery he came out to the waiting room to talk to me. Due to patient confidentiality the doctor asked me to follow him into a room to update me on the situation an discuss the outcome of the surgery and the state of the patient. The doctor upheld his ethical duty of respecting a patients privacy by bringing me into a different room to keep our conversation private.

I noticed something interesting while sitting in the waiting room. A older couple entered the facility and had a hard time hearing the receptionist. Therefore the receptionist spoke very loudly with the patient. During the conversation the receptionist made it a point to tell the patient that the facility was an ambulatory setting and that her advanced directive, living will, could not be honored there because it was not a hospital. The interesting part was the receptionist did not mentioned this to my boyfriend during check in. I wondered whether this was an issues of equality. Was the receptionist treating the patients differently because they were older or my boyfriend because he was younger? Then I wondered why the organization did not honor advanced directives, why would they not give the patients the choice , why was the organization was not interested in the values and the wishes of the patient.

H.C. Quality:Patient Perceptive

Explain Why or Why not the perceptive of the patient is the most important determinate of an adverse event.

I believe that the patient perceptive is important in determining an adverse event, however I don't believe it is the most important determinate. The text defines an adverse event as a patients experience of harm or injury from a medical intervention. The text further explains how there are different types of adverse events. The different types include, ones that are a result of an error and are consider preventable, and those that are not a result of an error but occur as a result of a careful planned and executed medical intervention. The later type is out of the control of the medical interventionist and results as an unpreventable consequence of the medical intervention itself. Patent's perspective is not one that is backed by medical knowledge and clinical experience and therefore is bias. Patients are emotional while receiving any type of medical intervention. Feelings of fear, anxiety, discomfort, pain, discrimination, anger, and denial can typical cloud the judgement of a patient. Patients may feel differently after having a procedure done and can contribute the abnormal feeling to an adverse event, when really it may just be a side effect of the recovery process. Trained medical professionals or other knowledgeable third parties should analyze the process and procedure to determine whether an adverse event has taken place. The analyze should be conducted using guidelines which are organization wide and widely accepted in the medical community. Evidence based medicine can help determine whether a preventable error may have caused an adverse event or whether a unpreventable adverse event has occurred. Patients are not qualified to analyze these types of situations or to conclude whether an adverse event has occurred.
Patients should however be included in the process. Communication should be open and flowing between the patients and those involved in the medial intervention. If the patient is not able to articulate their feelings after a medical intervention, then an adverse event may not be discovered. When this happens, an error can be repeated and harm can be brought upon other patients.

Ethics Week 5

Wow already on week 5... We are moving right along. Usually I write about the Track's We Leave book. This is because I always find the stories interesting and relatable, as well as something I can learn from. This week the reading was about graduate medical education. The chapter was full of information and very educational but didn't leave me with much to reflect on. This week I therefore will concentrate on the Manging Ethically readings. This should also help me think of a topic for my second mini-paper.

The first reading really stood out to me, it stated that clinical activity of health care executives should be limited to recruitment and retention of the best qualified staff and to then be responsive to legitimate requests for essential resources. The author then states that the executive have a moral obligation to ensure that patients receive the highest possible quality care. I completely agree with this. I think that in order to understand who is the best staff for your organization, you need to know who your patients are, what their expectations are and then monitor that your staff is meeting desired expectation. The author suggests making frequent patient rounds so that the opportunity for communicating with patients, physicians and nurses will arise. This could be very difficult for an executive to efficiently achieve. Any health care facility is very busy and the executive would not want to interfere with the activities already in process. However if the executive is knowledgeable about the way the organization is run, then they may be able to proper identify a reasonable time to effectively interact with those in the organization. This could be during the patient wait time before a procedure or their wait time associated with discharge. I also like the suggestion that the executive interact with the ethics committee on a daily basis. By doing this the executive will be able to easily identify any issues going on within the organizations that may need to be more closing monitored. This would have give the executive expert insight on the ways he can ethically deal with any situations he may have observed.
The next reading was about end of life decisions. This reading was interesting to me because it is similar to the topic in which my team will be debating, futile treatments. The author states that the decision to withhold or discontinue extraordinary or disproportionate means of medical intervention must be made with the judgment that the treatment itself is excessively burdensome or that the treatment is useless(not whether a persons life is not worth living). The topic for my debate is whether health care organizations should be able to refuse demands for futile treatments. I believe yes that health care organizations, maybe a specific panel designed for these types of situations, should be able to make the decision. Patients and their families may not be rationale in there thinking during these types of situations. Health care organization have the education to make informed decisions on whether a treatment is necessary, and with the help of an ethics committe they can determine if that decsion is also moral.

Ethics Week 4

This week was especially interesting to me because the reading in the tracks we leave book was about gender discrimination. I am a woman and these types of situations and their consequences are important for me to understand. The issue at Rolling Meadows hospital was tricky. When I graduate I hope to receive a fellowship opportunity in an acclaimed health care institution and this type of situation would not be one I would like to see myself in. In my own opinion I think it is not only the responsibility of the male to ensure he does not discriminate against a female but it also the females responsibility to keep her guard up. Whenever you are working closing with people, whether they are of the same gender or different gender, you will develop a relationship. That relationship can come in any form. It is a professionals or future professionals personal responsibility to maintain a productive and healthy relationship with the other people that they work with. This can often become hard when attractions, physical and not, have the opportunity to develop. My current job is a waitress and I work with several members of the opposite sex. The environment in which I work is fairly casual and professionalism is not a big issue. For me I think it may be difficult to transition into a different environment, one where gender discrimination and sexual harassment issues can become prevalent. Therefore this chapter in the book was highly enlightening and I aimed to absorb all the information presented. This is because I am beginning to mentally prepare myself to properly act in any situations that may arise in the future.
My first opinion in response to this chapter is I am completely against subordinate/ supervisor relations in an organization. As the book stated these types of relationships cause a hostile environment for workers. An environment where feelings of jealously, favoritism, and fear of expression can arise. Most jobs in themselves are stressful and the supervisor should be there to ensure that the employee isn't distracted while trying to perform at their best. Women should keep their guard up and not be vulnerable to put themselves in situations, such as the one stated in the text.
I also think that this situation may have been avoided had the protege keep in communication with the mentor and vice verse. The mentor had a responsibility to prepare the protege for the future and be emotionally secure. The moment that he may have felt inappropriate attractions were at play he should have communicated this with the protege. Being emotionally secure and rational may have saved the mentor from putting himself in this type of situation.
Personally I would like my mentor to be a female, one who has dealt with these types of situations first hand. As the text stated CEO's are predominantly male, but what the text didn't state was whether mentors are predominately CEO's. I would assume that most mentors are not the CEO's of an organization. I would assume that they are more time mangers of departments and positions such as that.
In out managing ethically book the readings were about leadership and ethics programs and committees. These reading kind of went hand and hand with the tracks we leave reading. The tracks we leave book gave the situation and then the manging ethically book gave examples of solutions that may have been implemented to avoid the problem. The solution being exemplary leadership and clearly defined ethics in an organization.

H.C. Quality Post 2- Wild Card

This week is a wild card blog entry, meaning a topic of my choice. It always seems harder for me to think of something to write about when it is my choice. It always seems easier to me to receive directions and then follow them. So this week for the sake of brain drain I am going to do a current event from the news. In my other class I have been reading and researching in the area of Managed care. One of the positives sides of managed care is that patients have shown to have fewer admissions and shorter lengths of stay at the hospital. One of the studies showed that Managed care patients spent 35% less time in the ICU (Hofmann, 2001,p.45 ). The quality of care received in a manged care environment can become an ethical issue. This is because in a traditional managed care setting you do not use a fee-for-service system, which can promote less treatments resulting in lower quality of care.

An article in relation to this issue, was in the news this week. The article is titles, the revolving door at the hospital. It talks about how patients over length of stay is shortening but the readmission rates are rising. This specific article is about Medicare patients with heart-failure. The study indicated that death rates for patients during hospitalization for heart-failure have decreased but rose after discharge. The article also quoted the vice president for quality and patient safety policy at American Hospital Association saying, "a reduction in 30-day overall death rates showed hospitals are doing better in caring for these types of patients." Studies presented in the article also show that 1 in 4 patients are readmitted for heart failure within 30 days of discharge. The factors contributed to these problem is a fragmented delivery system and conflicting reimbursement incentives (Winslow, 2010).

A fragmented delivery system and conflicting reimbursement incentives are great examples of quality issues in today health care. The health care reform legislation is attempting to control these issues. What I wonder is if these issues are controllable without a complete realignment of the overall health care delivery system. With so many different ways in which reimbursements are handled and health care is delivered, how can one be sure that quality service is given. I personally believe that a standard should be developed and mandated for all organizations, health care is not a typical business, it is essential to out population and their health and quality should be the most important outcome, not profit.

Hofmann, P.(2001). Managing Ethically: An Executive's Guide. Chicago: Health Administration Press

Winslow, R. (2010). The Revolving Door at the Hospital. Retrieved June 7,2010, from the Wallstreet Journal Web Site: http://online.wsj.com/article/SB1000014240527487039612045752809

H.C. Ethics Week 3

It's week three and we are moving right along!!! A lot of the reading this week had to do with managed care, which is a great topic to touch one when talking about ethical decisions. I plan on writing my mini-paper on manged care. I have not yet decided the actually topic but I feel that managed care relies heavily on providers and insurance companies making ethical decisions to benefit patients. This week another big portion of the reading was related to the importance of ethical programs, performing effective audits and creation of compliance boards and ethics committees. Having an effective and well defined system for ethics in an organization is very important to ensure that not only employees are making everyday ethical decisions but also top level executives. This is also extremely important for a managed care system, which is naturally suspect to unethical decision making. In the "Tracks we Leave" text, 6 principles of medical ethics are presented, which are in direct relation to manged care environments. Autonomy, Beneficence, Nonmalefice, Fidelity, Veracity and Justice and the 6 principles talked about in this chapter. The real question presented here is whether health care should be treated as just another business or should its own set of ethical principles and guidelines. Whether you answer yes or no, would determines where the loyalty of the physicians, and managers lies. This decision bring about ethical dilemmas for the physicians and managers.

Personally I think of my self as an ethical person and I do sincerely care about individuals. If i were a physician my loyalty would lye with my patient and their well being. In that situation I would think of health care as not just another businesses, it would mentally be separate. This decision might be too easy for me to make since I am not trained in this area, one might feel completely different when they are actually working the profession. For example my undergrad degree is in Business management so when I think of being put into the situation as a manger I might feel more inclined to look at health care from a business perspective. Stakeholders are different and the patient is not the only important outcome. When profits come in to play the game changes. Business can be cold hearted to the customer. The text specifically talks about marketing and in a manged care system how the optimal customer is young and healthy. So is it ethically to market to the young and healthy and exclude others if that is what is profitable to the business??? I would not like to be the one who makes that decisions. It is seems difficult to decipher what is appropriate. The book says no this is not appropriate ethical behavior, and calls this "cherry picking." In this situation the loyalty lies with the community and a duty to provide optimal health care for all, not just provide the highest profits for the organization.

H.C. Ethics Week 2

So this week we were assigned chapter 1 and 1a in "The Tracks We Leave" text. I LOVED this reading. Last week the reading was straight definitions and I had a hard time trying to piece things together in my mind what exactly ethical dilemmas implied. This week was so much different. The chapter starts out with a real life example of a typical ethical dilemmas that could happen. The situation itself, at Paradise Hill, was interesting and relatable. I wasn't sure if this was a real life example or a fictional one. After the situation was presented then the definitions were introduced, the different types of ethical issues. The explanation of the ethical issues was presented in the form of the questions you would ask yourself if you were encountering that ethical issue. Giving the question rather then a definition gave the explanation more meaning and made it more relatable to the reader. Next the ethical issues were related directly
to the situation at Paradise Hill, and backed up further through details of other documents related to the issue of medical errors, patients rights and ethical standards and codes.
All in all it was a great way for me to make a mental connection of the definitions. This connection will make it easier to apply the definitions to different situations by using this example as a reference.
Chapter 1a was also insightful and made me think of my values. This is something else hard for an individual to define. It is not something i often sit down and reflect upon. In the situation at Paradise Hill i would have had a hard if i were any one of the different people that were part of the situation. If i were the CEO it would be hard for me not to listen to my employees and their perceptive on the issue when I have different stakeholder such as the board members who felt a different way. In one section of the chapter the question of whether values are separable from facts. Facts are easier to defend, they are concrete and hard to argue against. However someone may value one fact's important over another. So does your role in life determine what your values are? and if that is the case, since our roles are ever changing and expanding are also our set of values?