Reference no: EM133051138
Disparagement of Professional Colleagues
As a member of a health profession, you have an obligation to be a peer to others on the health care team. Part of these obligations can be considered gatekeeping functions whereby you look out for the interests of the profession and of others in a similar practice. This sense of collegiality and mutual support is found in the earliest of codes when new practitioners undertook obligations to their teachers and the professional guild. The following statement is found in the Standard English translation of the Hippocratic Oath.
I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and covenant:
To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art if they desire to learn it without fee and covenant; to give a share of precepts and oral instruction to all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but to no one else.
The new practitioner, in taking the oath, bound himself to share knowledge only with those within the guild and to treat other practitioners equal to members of one's own family. From these early practices have come a series of traditions within the professions: to avoid the disparagement of other practitioners, share new therapies and technologies, offer professional courtesy for services, avoid sexual and other conflicts of interest, and look after the general welfare of the profession and those in practice. An unfortunate case of disparagement of colleagues occurred in the early 1980s when an allied health educator became disturbed by the number of ill-advised resuscitation efforts being called for in the local hospitals. To bring attention to the practice and to bring about needed reforms, the therapist wrote the following article for his local society newsletter:
A month or so ago, a young lady who had had two heart surgeries and a couple of (cardiac) arrests during the past two years, which resulted in hypoxic brain damage that had left her feeble minded and with a convulsive disorder, arrested again at home one evening because of a failed pacemaker. She was resuscitated and brought into the hospital, with no oxygen in the ambulance. There in the medical intensive care unit where everyone knew her from prior admissions, she arrested AGAIN about an hour later. Since she was not red-tagged, we were obliged to resuscitate her AGAIN, and put her on a ventilator. There she literally rotted away for three or four weeks (they had promptly fixed her pacemaker so that her heart wouldn't be able to stop again), until in spite of hell (which included dialysis for renal failure for over a week) she finally managed to "die."
Now, if one of the male staff had jumped into her bed and raped her, this would have been regarded as a criminal assault, and everyone would have been outraged, right? But what we did was far more damaging physically, far more protracted, and not one whit less immoral. Just the same, in the eyes of our curious social system, it was OK. Some system!
Thankfully, our systems and procedures regarding DNR orders have changed since the early 1980s when the therapist wrote the article. But even if you think the therapist was right in his outrage, the disparaging (talking ill of) fellow health care providers became the issue. The point of the matter was not whether he had an obligation to bring this problem to the attention of others and seek resolution; the problem lay in his presentation. Often in questions of morals, we feel so intensely about what we consider to be wrong that we consider those who do not share our point of view not merely wrong, but evil. His article went well beyond presenting a legitimate problem when he likened the physicians' practice to criminal assault and rape, or reckless irresponsibility. It is difficult to imagine that his manner of presentation gained him willing listeners among those he accused. Unfortunately, the article did not bring about the changes he sought, but instead harmed his career.
There are many problems in modern health care practice that need to be addressed, and the allied health practitioner and nurse have an important part to play in these discussions. The effectiveness of our input-the willingness of others to listen and to cause positive change-will have a great deal to do with the collegiality of our presentation and the positive nature of our proposals.
In practice, allied health and nursing personnel have long known that our physician colleagues were very loathe to criticize other physicians and practiced gatekeeping as part of their professional duties. This gatekeeping function, whereby one looks out for the interests of the profession or of others in a similar practice, comes as a result of our professional obligations and training, which lead to a strong sense of collegiality with others in our practice.
Yet as health care providers, we are often faced with the question raised by Cain: "Am I my brother's keeper?" As a member of a health profession the answer is often yes! Not only are we responsible for our actions in regard to the patient but we are also charged with the duty to ensure that the rest of the health team is practicing appropriate care.
In the NewsQuackademic Medicine
A well-respected physician who serves as full professor and Vice Chair of the Department of Surgery at an important American university medical center took on an additional position as host of a day-time television program. The program took his name, and became wildly popular with its focus on the physician giving advice on complementary medicine techniques and herbal supplements, such as those for weight loss. The show became so popular that his mere mentioning of a particular supplement often resulted in mega-success for the manufacturer.
The University received a letter signed by 10 physicians urging the University Medical Center to sever its ties with the physician, claiming that he is making a fortune promoting quack nostrums to the television audience. There appears to be a nugget of truth in the criticism, as the British Medical Journal reported that of 80 recommendations made from a sample of 40 episodes, showed that scientific evidence supported 40 percent, contradicted 15 percent, and was not found for 39 percent. Two of the descriptive characteristics of a profession are that they maintain a high standard of practice and are self-regulating. It is the self-regulating aspect that would allow fellow practitioners to report any colleague who did not maintain a reasonable standard of practice or involved themselves in unethical practice.
The physician states that he personally has investigated the various herbs he promotes and uses them in his own family. He feels confident in his recommendations, even if they are not backed up by scientific evidence.
1. Is it right for the 10 physicians to have sent the letter to the university administration calling for them to sever his relationship with the medical center?
2. Would a letter to the physician's professional organization's ethics committee asking for an investigation of the physician's activities been more appropriate?
3. Would it matter if at least one of the letter signers promoted GMOs? What if another denied "Global Warming"? What if one had spent time in jail for medical fraud?
4. The physician said he would fight this call for his dismissal on the basis of his "right of free speech." While it is true that a physician promoting "nonscientific therapies" would be covered by his legal right to free speech under the First Amendment to the Constitution, would this be a protection against a professional claim of unethical practice?
5. Who is in the right in this matter: the celebrity physician or letter-writing colleagues?
6. Do you see this as a matter of law, ethics, or professional etiquette?