Ethical Considerations in Ophthalmology Residency

The Basics

Navid Abolfat-h Zadeh1394

به نام خداوند بخشنده و مهربان

IRSO 25 is upcoming

IRSO is the most important Iranian ophthalmologists’ annual meeting,

but unfortunately , you could not find at least one specific session covering ethical issues in IRSO.

Recently, AAO 2015

• The Jensen Lecture, provided by redmond ethics center.

• This year: Carl Elliott MD,PhD “The Dark Side of

Medicine”

AAO

Every physician needs skills for addressing unprofessional/unethical behavior.

Professionalism

Failing to address unprofessional behavior may promote similar behavior in other individuals and tarnishes the image of the profession.

Addressing unprofessional behavior results in higher levels of personal satisfaction, creates better mentors for younger ophthalmologists, and improves patient safety and risk-management experiences.

Dr. Jensen Says

“Ethical issues come up every day that haven’t been covered in our residency or training programs. These are practical questions for every resident, intern and doctor to consider, not just members of an Ethics Committee,”

“The key is making sure that we actually look at these ethical questions — that we don’t automatically assume we know the answer.”

“These questions require some thought and some instruction and someone to talk to us about them.”

The Final Goal of Residency

The ophthalmology residency graduate is not only expected to be clinically competent in the correct application of clinical knowledge and skills in solving the patient’s medical problem.

The graduate is also expected to apply that ability in a way that is cost-effective, efficient, ethical, and sensitive to the patient and to societal and professional imperatives.

Ethics

• Ethics is the systematic study of what is right and good with respect to conduct and character.

• As an intellectual discipline, ethics is concerned not only with making appropriate decisions about what we ought to do, but with justifying those decisions.

Medical Ethics

• Medicine is a moral practice, because physicians are concerned primarily with advancing the interests of patients and doing for patients what they wish to have done for themselves.

• The physician places the interests of patient above her or his own interests.

Ethical Dilemma

• A situation in which two or more choices are morally justifiable, but only one is capable of being acted on at a particular time, represents a moral dilemma.

• How could we resolve an ethical dilemma?

Codes of Ethics

• A code of ethics is a statement of general principles of duty to which the members of the profession commit themselves, and through which the profession is given its moral character.

• The AAO Code of Ethics, recognizes a commitment to respecting patient autonomy and to provide services with “respect for human dignity” and “honesty.”

AAO Code of Ethics - 2014

• Ethics address conduct and relate to what behavior is appropriate or inappropriate, as reasonably determined by the entity setting the ethical standards.

• An issue of ethics in ophthalmology is resolved by the determination that the best interests of patients are served.

AAO Code of Ethics - 2014• Competence:Competence can never be totally comprehensive, and

therefore must be supplemented by other colleagues when indicated.

Competence involves technical ability, cognitive knowledge, and ethical concerns for the patient.

Competence includes having adequate and proper knowledge to make a professionally appropriate and acceptable decision regarding the patient's management.

AAO Code of Ethics - 2014

• Communication with the Patient:Open communication with the patient is

essential. Patient confidences must be safeguarded

within the constraints of the law.

AAO Code of Ethics - 2014

• Fees for Ophthalmological Services:Fees for ophthalmological services must not

exploit patients or others who pay for the services.

AAO Code of Ethics - 2014• Corrective Action:If a member has a reasonable basis for believing that another person

has deviated from professionally accepted standards in a manner that adversely affects patient care or from the Rules of Ethics, the member should attempt to prevent the continuation of this conduct.

This is best done by communicating directly with the other person.

When that action is ineffective or is not feasible, the member has a responsibility to refer the matter to the appropriate authorities and to cooperate with those authorities in their professional and legal efforts to prevent the continuation of the conduct.

Case ReviewA patient called for a second opinion following her recent

cataract surgery, as she was unhappy with her postoperative visual outcome. Once in my office, she asked if I could help her vision. I was unable to improve her visual acuity better than the 20/80 level; I also noted a vitreous strand to the surgical wound with a peaked pupil, and a sulcus IOL. An OCT revealed macular edema. The patient had a copy of her chart from her operating surgeon, which stated that the IOL was placed in the bag and there were no complications. How should I tell the patient about the surgical complications that are likely contributing to her suboptimal visual acuity?

Case ResolvingJean R. Hausheer MD, states:

When a dissatisfied patient seeks out a second opinion following cataract surgery, first collect all pertinent facts and data. This includes a thorough patient history, a comprehensive ocular examination, a review of the prior ophthalmologist’s medical and surgical records, and, ideally, a discussion with the surgeon of possible etiologies for the patient’s symptomatic lens implant problems.

Only after all this information has been gathered can the patient be properly diagnosed and informed. Often, sympathetic and careful management is enough to mitigate a patient’s dissatisfaction and avert unwarranted malpractice litigation.

AAO Code of Ethics - 2014

• An Ophthalmologist's Responsibility:It is the responsibility of an ophthalmologist to

act in the best interest of the patient.

• Professional Integrity in Research: Professional relations with industry regarding

research should advance the best interests of patients and the profession.

AAO Code of Ethics - 2014• Community Responsibility:The honored ideals of the medical profession imply that

the responsibility of the ophthalmologist extends not only to the individual but also to society as a whole.

Activities that have the purpose of improving the health and well-being of the patient and/or the community in a cost-effective way deserve the interest, support, and participation of the ophthalmologist.

AAO Code of Ethics - 2014

• Rules of Ethics:They are mandatory and descriptive standards

of minimally-acceptable professional conduct.

AAO Code of Ethics - 2014• Pretreatment Assessment: Treatment shall be recommended only after a careful consideration

of the patient's physical, social, emotional and occupational needs.

The ophthalmologist must evaluate the patient and assure that the evaluation accurately documents the ophthalmic findings and the indications for treatment.

Recommendation of unnecessary treatment or withholding of necessary treatment is unethical.

AAO Code of Ethics - 2014

• Procedures and Materials:Ophthalmologists should order only those

laboratory procedures, optical devices or pharmacological agents that are in the best interest of the patient.

Ordering unnecessary procedures or materials or withholding necessary procedures or materials is unethical.

AAO Code of Ethics - 2014

• Commercial Relationships:An ophthalmologist's clinical judgment and

practice must not be affected by economic interest in, commitment to, or benefit from professionally-related commercial enterprises.

AAO Code of Ethics - 2014

• Conflict of Interest:A conflict of interest exists when professional

judgment concerning the well-being of the patient has a reasonable chance of being influenced by other interests of the provider.

• Confidentiality:An ophthalmologist shall respect the confidential

physician-patient relationship and safeguard confidential information consistent with the law.

Thank You

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