Professionalism

Professionalism December 6, 2009 Panelists:

Seven Deadly Sins of Professionalism • Abuse of power / lust • Arrogance / Anger • Greed • Conflict of interest / pride • Misrepresentation / envy • Impairment / substance abuse / gluttony • Lack of conscientiousness / sloth / “pwedena” Dr. Andrew Lee Prof. of Ophthalmology

A Second Opinion • Video: • A patient seeking a second opinion • It is not clear what the second doctors opinion is of the patient’s illness • The second doctors opinion of the first doctor – “Dr. Taga, Dr. Patay” • What is the sin? (arrogance, greed, conflict of interest, misrepresentation)

Issues on Second Opinions • What is the patient’s right to a second opinion? • If you were the first doctor? • I always encourage my patients to ask for one • I am the best, no second opinion is needed

Issues: • Who should you send your patient to for a second opinion? • I will send my patient to my friend who will not steal my patient • I will first ask the patient if he knows any other surgeon, if not, I will recommend someone (better than I am?) • I am obliged to send my patient to an expert • I will send my patient to my enemy because it is a complicated case

Issues: • If you were the second surgeon and the diagnosis or planned treatment is Obviously Wrong, how would you tell it to the patient? • Give a derogatory opinion on the qualifications of the first surgeon esp. if not a diplomate or fellow of PCS • Never give derogatory remarks • How should one tell the patient that the diagnosis or treatment plan of the first surgeon is wrong?

Issues: • What if your opinion is the same? • I will say that the first surgeon is credible and send the patient back to him • I will sell myself to the patient (I am better actually, choose me!) • I will let my patient choose freely without any unnecessary comments (good or bad)

Issues: • The patient is actually just shopping around for a “Cheaper Surgeon” • I will lower my actual fee to a level lower than the first surgeon • I will lower my actual fee to match that of the first • This is my fee, “Take it or leave it!”

Issues: • The patient finally chooses you for whatever reason. • I will inform the first surgeon that I am taking over his patient • I will ask the patient to tell the first surgeon • There is no obligation on my part or the patient to inform the first surgeon

I Know How to Do It? • Patient consulting an ophthalmologist • The patient needs an operation • The patient learns of a new procedure which he chooses to be performed on him • The surgeon claims he can do it. • Without the knowledge of the patient, the surgeon calls an expert friend to do it with him. • Fee is split after. • What Sins? (Misrepresentation, conflict of interest, greed)

Issues: • If you were the surgeon on the video? • I will do the same, there is nothing wrong about it (the patient will receive proper care anyway) • I will tell the patient the truth and send him to an expert • I will tell the patient the truth but will tell him I have a colleague who I can call to help me do it

Issues: • What if you are the second surgeon? • I will do it for my friend anytime • It is ok to do it if I don’t receive any fee, I am helping a friend • I will do it only if the patient is properly informed

Issues: • The patient is properly informed. On the matter of the professional fee of the “helping surgeon” • Should just let the first surgeon decide on the amount • Should charge separately for his services • Should not charge at all

Issues: • What should be the institutional safeguards against “Ghost Surgery” • Credentialing: • There should be individual accreditation for specific operations that a surgeon is allowed to do • Sanctions for erring surgeons?

I’m the Boss! • Parking in a no parking zone, obstruction of driveway • The late surgeon – tardiness • Unwanted sexual advances • The angry surgeon in the OR • What are the sins? Abuse of power, arrogance

Issues: • Obstruction of driveway, no parking: • I am the boss, I can do whatever I please • Sorry, I was in a hurry just this time • I will never do this, the boss should set a good example

Issues: • The late doctor, tardiness • I am the boss it is only right that people wait for me • Doctors are busy people and it is understandable that they may be late once in a while • I make it a point that I come on time as a show of respect for other people’s time

Issues: • Unwanted sexual advances: • You’re over reacting, I’m just being playful, it’s harmless! • It’s ok if it’s between consenting adults • It’s just not proper, period.

Issues: • The angry surgeon in the OR, disruptive behavior • Surgery is stressful work, it’s ok for him to lose his temper (Sometimes? All the time? He’s the boss) • I am the captain of the ship. I have a right to be angry if the members of the team are not performing up to par • People tend to be more alert when I am angry • I can get what I want without being angry

Issues: • What are the institutional safeguards against these unwanted behaviors in the department level or higher? • Departmental rules and regulations • Ethics committee • Quality assurance • Legal department • Others?

Professionalism