Medical Professionalism: How to Handle Lapses and Evaluate Professionalism in Your Program

Transcription

1 Medical Professionalism: How to Handle Lapses and Evaluate Professionalism in Your Program Dr. Rachel Simmons Boston Medical Center Dr. Craig Noronha Boston Medical Center Dr. Nicole Swallow Hershey Medical Center Dr. Jeffrey Yourshaw Hershey Medical Center Disclosures

2 Learning Objectives Define medical professionalism and its major elements Analyze and discuss examples of lapses in medical professionalism Utilize a tool to evaluate medical professionalism in an internal medicine residency program Agenda Overview of medical professionalism Case Discussions Introduction to an Evaluation Tool Wrap up

3 Getting to know you Break into groups of four In 2 minutes, see how many similarities you can find between the four of you Write them down and be prepared to share! Medical Professionalism Why this is important for Chief Residents

4 Medical Professionalism for Chiefs You will hear about lapses- hallway conversation, s, meetings You may be asked to be part of the solution Lapses in professionalism can affect morale People who have exemplary professionalism is who we admire and want to work with How do you define Professionalism in Medicine? Large group discussion

5 How do you define lapses in Medical Professionalism? I shall not today attempt further to define the kinds of material I understand to be embraced within that shorthand description porn, and perhaps I could never succeed in intelligibly doing so. But I know it when I see it, and the motion picture involved in this case is not that by United States Supreme Court Justice Potter Stewart Elements of a profession Common body of knowledge Commitment to self assessment Professional accountability Altruism Self regulation Mentoring in Academic Medicine. Holly Humphrey

6 ABIM Charter on Professionalism (2002) Primacy of Patient Welfare The principle is based on a dedication to serving the interest of the patient. Altruism contributes to the trust that is central to the physician-patient relationship. Market forces, societal pressures, and administrative exigencies must not compromise this principle. ABIM Charter on Professionalism (2002) Patient Autonomy Physicians must have respect for patient autonomy. Physicians must be honest with their patients and empower them to make informed decisions about their treatment. Patients decisions about their care must be paramount, as long as those decisions are in keeping with ethical practice and do not lead to demands for inappropriate care.

7 ABIM Charter on Professionalism (2002) Social Justice The medical profession must promote justice in the health care system, including the fair distribution of health care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category. ACGME Internal Medicine Reporting Milestones Respectful interactions with patients, caregivers, and inter-professional team Accepts Responsibility and Follows through on tasks Exhibits integrity and ethical behavior in professional conduct Responds to each patient s unique characteristics and needs

8 With Great Power come Great Responsibility Francois-Marie Arouet aka Voltaire Rephrased/Reused by Franklin D Roosevelt Winston Churchill Uncle Ben- Spiderman Comics/Movies What are the Privileges of being a physician Discuss among your colleagues

9 Privileges of being a physician Patients trust you with their lives and their story Respect from patients, community, and society Comfortable income and job security Power to make changes in individual patient s lives, community, and government Role model for future physicians and other health care providers Work has inherent meaning Case 1- Small group discussion It is October 1 st and intern A is getting comfortable with his intern duties. He is often 5-10 minutes late for signout rounds and team rounding. He always shows up to team rounds with a cup of coffee that he bought from the cafeteria. The whole team usually waits for him before starting rounds, but given how often it was happening, the resident started rounds without him. When asked why he was late, he says that he was running late rounding and he had some sick patients. He also shows up at least 5-10 minutes late for conferences including ambulatory conferences. Intern A wears scrubs and hoodies on most days including at times to continuity clinic. On a few weekend days he has worn expensive jeans and a t-shirt to work, but worn a white coat over his clothes. The attending on a ward team who is also the clinic preceptor for the resident approaches you about these issues. How does professionalism relate to being punctual? What is an appropriate dress code for physicians? Does the dress code differ based on location, time, and patients? How would you deal with this issue as a chief resident?

10 How are lapses in professionalism handled in a residency program? A. Taken out back and shot B. Eye for an eye C. 6 extra shifts of night float D. Group hazing E. 32 lashes and 2 MKSAP questions F. All of the above How are lapses in professionalism handled in a residency program? Chief resident role Program Director role Associate Program Director role Clinical Competency Committee Role (CCC) Attending Role GME/Chief Medical Officer/Possibly Hospital HR

11 Evaluation and reporting tools for specific lapses in professionalism Be specific about problem Label behavior not person Provides specific language and society generated milestones to use in discussions with residents Track issues- one major issue vs multiple minor issues that add up over time Can be useful for chiefs and program in the future- this resident did this stuff as an intern Evaluation and reporting tool for specific lapses in professionalism- one example

12 Case 2 Small Group Discussion A junior resident posts on Facebook about her experience with one patient on a recent ward rotation. No patient identifiers were used in the initial post. There were multiple subsequent posts by the resident along with comments from fellow residents which added to the description of the patient admission. Nursing staff brought the issue up with the administration as they felt HIPAA had been compromised as many providers were able to tell who the patient was from the string of conversation. The junior also uses Facebook to complain about other services such as I hate orthopedic residents, they forget all their medicine, dump on medicine, and fight all the consults we put in. What lapses in professionalism do you identify in this case? What is appropriate to post on sites like Facebook? How would you approach this case? AMA Policy on Social Media 11/9/2010 Encourages Physicians to: Use privacy settings to safeguard personal information and content to the fullest extent possible on social networking sites. Routinely monitor their own Internet presence to ensure that the personal and professional information on their own sites and content posted about them by others, is accurate and appropriate. Maintain appropriate boundaries of the patient-physician relationship when interacting with patients online and ensure patient privacy and confidentiality is maintained. Consider separating personal and professional content online. Recognize that actions online and content posted can negatively affect their reputations among patients and colleagues, and may even have consequences for their medical careers.

13 Annals of Internal Medicine April 16 th, 2013 Online Medical Professionalism: Patient and Public Relationships: Policy Statement From the American College of Physicians and Federation of State Medical Boards Potential Online Physician Activities Communication with patients using , text, and instant messaging Use of social media sites to gather information about patients Use of online educational resources and related information with patients Physician-produced blogs, micoblogs, and physician posting of comments by others Physician posting of physician personal information on public social media sites Physician use of digital venues for communicating with colleagues about patient care From: Online Medical Professionalism: Patient and Public Relationships: Policy Statement From the American College of Physicians and the Federation of State Medical Boards Ann Intern Med. 2013;158(8): doi: / Date of download: 3/4/2015 Copyright American College of Physicians. All rights reserved.

14 Excerpt from: For doctors, social media a tricky case- Boston.com April 20 th, 2011 Dr. Alexandra Thran, 48, was fired from the hospital last year and reprimanded by the state medical board last week. The hospital took away her privileges to work in the emergency room for posting information online about a trauma patient. Thran s posting did not include the patient s name, but she wrote enough that others in the community could identify the patient, according to a board filing. Five nurses fired for Facebook postings JENNIFER FINK, RN, BSN JUNE 14, 2010 SCRUBSMAG.COM Five California nurses were recently fired after allegedly discussing patients on Facebook. No patient names, photos or identifying information were included in the posts.

15 Amy Dunbar, OB-GYN, In Hot Water After Posting Comment About Patient On Facebook Huffingtonpost.com 2/6/2013 How do highlight and reward residents who exemplify high levels of professionalism Kudos on weekly s Maybe box for co-residents to praise peers An end of year/residency award for Professionalism or aspects of professionalism Peers, other health care workers, patients, students 360 evaluations

16 6 D s of unprofessional behavior- potentially reversible causes Depression Deprivation (sleep, food) Distraction (finances, family/so, illness) Disability (neurocognitive, physical) Disordered personality (ADHD, borderline) Drugs (alcohol, narcotics) 2 sides to every story- Considerations Have to deal with outside issues as well as lapses in professionalism Just because there are outside issues does not make it right

17 Top Tips 1) Model professional behavior including dress code as a chief resident 2) Do not let prior friendships with residents take precedent over your duties 3) Learn your policies Residency, GME, HR, Hospital wide, Department 4) When handling ANY issues hear both sides of the story before coming to a conclusion 5) Be a good listener 6) Consider other factors 6 Ds 7) Set clear expectations work with the program, department, and hospital leadership 8) Feedback should be timely and specific 9) Label behavior(s) not resident 10) Document issues especially non patient related issues 11) Seek advice from your superiors when there is an unclear answer to the problem 12) Talk early and often with each other, program leadership and CCC 13) Establish clear follow up Twelve tips for addressing medical student and resident physician lapses in professionalism. Rougas S 1, Gentilesco B, Green E, Flores L. Med Teach Feb 10:1-7. [Epub ahead of print] Pick a Case Small group discussions

18 Summary As a chief resident you will observe poor and exemplary behavior Work with your co-chief residents, program office, CCC to develop and adhere to standards for professionalism Consider a standardized approach to lapses in professionalism including using an evaluation tool Consider the 6Ds It is not all bad, remember to recognize your outstanding residents and that there are many privileges to being a physician.and BEING A CHIEF RESIDENT Contact information Craig Noronha Rachel Simmons Nicole Swallow Jeffrey Yourshaw craig.noronha@bmc.org Rachel.simmons@bmc.org nswallow@hmc.psu.edu jyourshaw@hmc.psu.edu

19 Resources Twelve tips for addressing medical student and resident physician lapses in professionalism.rougas S1, Gentilesco B, Green E, Flores L. Med Teach Feb 10:1-7. Online Medical Professionalism: Patient and Public Relationships: Policy Statement From the American College of Physicians and the Federation of State Medical Boards. Annals of Internal Medicine. 2013;158(8): doi: / Professionalism in the Digital Age Arash Mostaghimi, MD, MPA; and Bradley H. Crotty, MD Annals of Internal Medicine. 2011;154(8): doi: /