Dilema seorang doktor PART I

Physicians’ Top 20 Ethical Dilemas
Medscape 2010 Physical Ethics Survey

*Komen dari doktor yang berwarna merah

“I once had a terminal patient who wanted to see his granddaughter before he died, so I prolonged his intravenous therapy for 3 days until she arrived. He died the same night.”
“Some families have completely unrealistic expectations, despite my educational efforts. I would give continued care, but not happily.”
“I do not have the right to determine futile unless the patient is brain dead. Futility is a matter of opinion. We all will die eventually.”
“I would not recommend it if I thought it was futile, but I would give it if that is what the patient or the family wanted.”
“Why waste money and time when results are nil?”
“I would do this if I felt it would give the family time to accept the inevitability of death.”

“I do not participate in active withdrawal of such intrinsic life-sustaining needs. The family could find another physician if they feel so strongly.”
“It depends on what you mean by ‘premature.’ I would feel differently if death is imminent and there’s no hope, and the quality of life is poor rather than if there’s no hope but some quality, or if there is some hope but the quality of life is lousy. I’d always try to think, what would the patient want.”
“Not if the family insisted, but if the patient insisted on it, I would.”
“This is why hospitals have ethics boards. I would refer cases like these to experts.”

“I think we do this all the time, with patients coming in with viral urinary tract infections who want antibiotics because they think it is the only thing that will help them.”
“Lying to patients about treatments is never OK.”
“I’m experienced enough to know that I can’t help everyone, and I’m egosyntonic with being the occasional disappointment to my patients.”
“A placebo produces a 30% improvement in some studies.”
“Why not save money and risk for adverse effects by just prescribing placebos in cases when medications are clearly not indicated?”

“Pain should not be undertreated, and what’s the problem with a terminal patient being addicted and comfortable?”
“Pain is undertreated all the time in my city. There is a great deal of fear of the Drug Enforcement Administration and reluctance to use narcotics even when they are indicated. Studies show that addiction is seldom an issue if the pain is real.”
“I would never undertreat a patient’s genuine pain. I would withhold narcotics from a chronically addicted patient who is presenting with a questionable painful condition (eg, back pain or toothache) and offer nonnarcotic alternatives.”
“Having been sanctioned by an out-of-control, vindictive state medical board, such things aren’t even in the purview of ethics, but rather a survival mechanism for my ability to continue practicing.”

“Most of the time, I tell them exactly as it is; they need to know the truth, and who am I to judge what they should or shouldn’t know? However, if the patient is very frail emotionally and physically and has a very supportive family, I may not.”
“It’s not about hiding information. It’s learning how to talk to patients and giving bad news in the best way possible. All the information should be given, but any positive that exists should be also talked about.”
“The truth, delivered with compassion, is a gift.”
“I think patients deserve total honesty from their physician. They want to know.”
“An elderly patient who is senile will not understand, benefit, or prepare, so it is senseless to inform them. However, a family member, next of kin, or whoever is the health proxy will be notified.”

“Cover-ups are never OK.”
“Everyone makes mistakes, but physicians are punished for their mistakes. I don’t believe in covering up information, but in today’s litigious society, a simple mistake could cost a physician his or her license.”
“The more open the physician is about mistakes, the more acceptable mistakes will be to the patients.”
“Why make a mountain out of a molehill if it will cause the patient more emotional upset than simply not saying anything, as long as no physical harm has occurred?”
“Do I balance the potential harm to a patient vs the potential harm to myself in publicly announcing ‘a mistake’? Yes.”
“I own up to all mistakes I make, but I explain their impact or lack thereof.”

“I would, but I would contact an attorney first.”
“Yes, but I would tend to seek out advice from a risk manager or more seasoned physician for help in how to reveal the mistake.”
“I will reveal any mistakes, especially those that could harm a patient. That is the morally correct thing to do.”
“We take an oath to do no harm. Covering up is a form of lying.”
“If revealing the mistake won’t change the management and it has not yet caused any harm, I think a wait-and-see approach is OK.”

“Often, defensive medicine is sloppy medicine. A chart note explaining care is often a better defense.”
“Some patients want reassurance, and in some cases, testing helps to prevent further unnecessary medical care.”
“Yes, it’s acceptable: A jury of 12 men will always be found by an enterprising trial lawyer that will find you guilty of not doing all you could have done.”
“We must get away from ‘I-did-this-to-protect-myself’ medicine. It is costly and exposes the patient to added, unnecessary risks.”
“I consider it a criminal act.”

“A competent patient who has been adequately medically informed and has a terminal condition that makes his or her life miserable with no chance of cure or amelioration should be allowed to look into all options. We may not agree with it, but we have no right to legislate anyone into intractable suffering.”
“Palliative care is one thing, but suicide is not within the scope of acceptable physician behavior.”
“I do not believe in assisted suicide, but I do believe in withdrawal of support. If the patient is terminally ill and suffering and there is absolutely no hope to survive, then I withdraw the support (eg, antibiotic treatment, blood testing, or transfusions).”

“As a profession, medicine cannot allow those who are impaired by any reason to expose patients to danger.”
“I would not report him to the board, but I would consider talking to a superior. The board is not designed to help, rather to punish and demonstrate their ‘value.'”
“I would like to think I would, but it has happened when I did and didn’t.”
“I would, but only after firm warning that this is my intent and after multiple discussions with this impaired colleague.”
“I have done so and consider it an act of love. A year after having done so, the physician and spouse both thanked me.”

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