Sunday, June 26, 2016

Lebron James and Medical Ethics - Let Me Explain.

Medical ethical issues confront physicians daily.  Most of us contemplate ponderous ethical dilemmas, such as end-of-life care care, allocation of the limited supply of organs for transplant or our unequal access to health care.  Many ethical decision points are rather quotidian, not situations that would serve as content for bioethical conferences.

Here are some examples of everyday ethical issues that physicians deal with.
  • A patient asks his doctor to support a claim for disability that is not warranted.
  • A patient asks his gastroenterologist to change his constipation diagnosis after the fact so that his colonoscopy is covered more fully by the insurance company. 
  • An employee in a doctor’s office, whose own doctor is booked solid, requests an antibiotic prescription for a urinary tract infection from her physician boss.
  • A physician falsely claims to an insurance company that he has tried certain medicines on a patient in order to gain approval of a desired medication.
  • A doctor tries to limit diagnostic testing of a patient with no insurance in order to save the patient money.
This past week, I had a request from a patient under very unique circumstances.  I performed a colonoscopy on a young man this past Tuesday.  Prior to the procedure he remarked “that he needs a really big favor from me.”  Such phrasing portends an improper request.   Would he be asking for pain medicines or to sign off that he needed light duty for the rest of the week?  He wanted me to give him a medical excuse for Wednesday, the day after his procedure. 

From time to time, we have requests from patients for work excuses on the day prior to or following their procedure.  Nearly all of these requests are politely, but summarily denied 

The Curse is Broken!

Wednesday, 6/23/16, was not an ordinary day in Cleveland.  There was going to be a once in a lifetime celebration downtown for the triumphant Cleveland Cavaliers, who bested the Golden State Warriors in an epochal championship series.   Contemplate the narrative.  A poor kid from Akron is raised by a single mom under very challenging circumstances.  His talent leads him to the Cleveland Cavaliers where he brings hope to a city that has been cursed with sports failures.   He leaves Cleveland in a clumsy, arrogant and ‘cavalier’ manner for the Miami Heat where he picked up some rings.  The poster boy became a Cleveland doormat.   He returns home to keep a promise.  We lose to the Warriors last year.  Now, we win against them by a whisker in game 7.   Cleveland hasn’t had sports championship team in over half a century.  We have suffered under a curse.

Even folks like me who are not sports fanatics have been swept up into this movement.  We are so proud of our amazing team and the fans who, like Moses, had been permitted to look upon the Promised Land, but not to enter it, until now.

How should I have responded to my patient’s request?


  1. Of all the ethical dilemmas listed, days off for a procedure is the least egregious. Whats the harm? Just give them a few extra days off to recover from the anesthesia, soreness, mental anxiety, etc. I actually find that just as many patients want go back to work too soon.

  2. And by the way, please don't try and make us physicians feel more guilty than we already do. Each of these ethical dilemmas you so accurately listed and we physicians struggle with every day, don't even compare to the ethical violations by Congressman. Congressman have also sworn an oath of office. Yet, violating these ethics is just part of the job description of a Congressman. You think they "struggle" with those ethical scenarios? Abuse of office, unethical favors, unethical camaign contributions. Heck, its not only unethical, its illegal in their case. But you, the doctor, loses sleep, not the Congressman. Show me one Congressman blogger thats asking the public: "Hey guys, is that $50,000 donation I received from Pharma to vote "no" to the Medical Device Tax unethical? What should I have done?"

  3. These are great questions. Answers top to bottom: no, no, yes (explanation below), no and it depends. If I am going to see an employee at their request they must clock out and become a patient. They are treated as a patient with a history, PE, UA and then given an rx if needed and must schedule a follow up. as to your last question, that is tough. I usually discuss the dilemma with the patient and let them decide to have test or not then record that information in the note.

  4. Good points, all. Re our legislators, agree they are ethically disabled. There's a reason that their approval rating is hovering above single digits. @MommyDoc, agree that treating an employee is acceptable, if the individual is treated as an actual pt, as you point out. For obvious reasons, an employee who is a patient is at risk for breaches of confidentiality despite efforts to maintain it. MK