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Being honest


Practising with integrity and trustworthiness

Honesty and integrity with patients


Female medical studentConsider the following cases highlighting honesty and integrity with patients.

Case: Taking advantage of a false assumption
Graphic image of suturing scissors

Background

A third-year medical student is introduced by her supervisor as Dr. A to a patient in the emergency department. The supervisor does not explain either Dr. A's status as a medical student or her role in the patient's care.

Having determined that the patient requires sutures to close a laceration on her forearm, the supervisor asks the patient if she would mind if Dr. A performed the procedure. The patient seems indifferent as to who does the procedure, stating that "one doctor is as good as the next."

The medical student realizes the patient believes she is an emergency physician. This makes the student feel uncomfortable. However, knowing the suturing experience will help her in her surgery rotation and not wanting to discourage the supervisor from providing additional learning opportunities, she does not correct the patient's assumption.

Think about it

  • Although hands-on learning opportunities are important, is it appropriate to mislead patients about your educational status?
  • How does the failure to correct a patient's assumption about a student's status threaten both the patient's safety and trust in the healthcare system?
  • How might the pressure to perform lead a medical student to consider compromising ethical values?

Suggestions

  • Informing patients of a medical trainee's status is integral to both patient safety and respect for the patient.
  • Medical students and residents should introduce themselves and identify their educational status to patients.
  • The patient may refuse to be assessed or treated by a trainee for all or part of their care. Reasonable attempts should be made to meet a patient's needs in these circumstances.
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Case: Too rushed to think
Female patient beside male physician looking over her chart

Background

A clerk on a surgery rotation is asked by the surgeon to discharge a patient. The surgeon informs the clerk that if he completes the discharge in time, he will have the opportunity to assist with the next surgery, an appendectomy.  

Having never had the opportunity to assist with a surgery before, the clerk is eager to participate and rushes through the patient discharge instructions.

Despite being given clear instructions from the surgeon, the clerk, in his excitement and rush, fails to inform the patient about appropriate follow-up, including signs and symptoms indicating a need for further medical care.

Think about it

  • Are the clerk's actions unprofessional in this situation?
  • What other factors might be causing the clerk to act in this way?
  • What effect could the clerk's omission have on the discharged patient's clinical outcome?
  • What can the clerk or supervisor (surgeon) do in this situation to prevent patient care from being compromised?

Lessons learned

  • Every patient deserves appropriate care and attention, and this is a responsibility of physicians and trainees.
  • While exposure to surgeries and other procedures may be exciting, it is unprofessional to compromise a patient's care to further your training.
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Case: Request for a disability note
Female patient smiling up at physician

Background

You are working as a clerk with a dermatologist in the outpatient department. You have carefully reassessed a patient with a resolved contact dermatitis. You explain how to avoid contact with the offending allergen and reassure the patient that she can return to work.

The patient asks the supervising dermatologist to sign a disability form for her to remain off work for an additional two weeks so that she can go on a vacation. She threatens to take legal action if the dermatologist does not sign the form.

Think about it

  • Should the dermatologist sign the disability form to avoid the threat of medical-legal difficulty?
  • What are the pressures on the dermatologist?
  • What could the dermatologist say to this patient?

Lessons learned

  • Physicians are regularly asked to sign forms on behalf of patients to allow them to receive disability, sick leave, or injury benefits.
  • Physicians are responsible to ensure the reports they prepare are timely, accurate, honest, and reasonable.
  • Even if a patient threatens legal action, a physician is obliged to refuse to provide an inappropriate report that conflicts with their medical judgment.
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