Quality Blog #3: Patient Perspective and Adverse Effects

Adverse effects are also called side effects and can result from a reaction to a drug or surgery. They are considered events that cause harm to the patient. The patient’s perspective is a very significant aspect when discussing adverse events. This is true particularly because patients are the party most affected by the event. If the patient does not offer insight, the physician may not be aware that anything has occurred. Therefore this makes the patient’s perspective the most important determinant in perspectives on adverse effects.

A patient’s viewpoint also gives health care professionals an idea of how certain drugs or surgeries are affecting certain patient populations. For example, if health care professionals are noticing that diabetic patients are experiencing nausea from a certain medication, one could assume that this is an adverse effect for these patients. If this information had not been communicated by the patient, the clinician may not have been aware of the effect.

Adverse events can vary from mild to severe, including death. If these events can result in the death of a patient, the patient’s perspective is vital. If I needed to inform my physician about trouble I have been experiencing with a drug, I would expect the physician or other health care professional to take my concern seriously. If the physician chooses to research the side effect, it could lead to others classifying my problem as an adverse effect which could prevent harm to other patients who are given the same medication in the future. This is another example of how a patient’s insight could lead to determining whether an adverse event has occurred.

Health care professionals should also try to use the patient’s perspective as much as possible because it allows for more efficient and effective care for the patient. Without insight and feedback from patients, the affects of a drug may go unnoticed, which could create problems for the patient and health care professional in the future; which could reduce the quality of care given to patients. Reports from patients also allow health care professionals to make improvements in care (Ransom, Joshi, & Ransom, 2008). It is important for health care professionals to understand how these events affect their patients. If they have a better understanding of this, they are able to provide better care to patients as well.

Reference

Ransom, Elizabeth, Joshi, Maulik, & Ransom, Scott. (2008). The Healthcare quality book. Health Administration Pr.

Ethics and Honesty

Honesty is one ethical principle that is violated every day. People violate this principle in their personal lives as well as in their working environment. People often do not realize the severity of dishonesty and how it could affect someone else. In health care dishonesty can turn into a serious event. For instance, if a physician chooses not to disclose a patient’s true condition to them and the patient goes untreated. This case of dishonesty can turn into negligence on the health care professional’s part.

I was reading a case in which a physician neglected to tell a patient that she had cancer because the husband asked the doctor not to (Pozgar, 2005). The doctor and the husband thought the wife’s condition would get better. The patient turned out fine for awhile but had to be admitted into the hospital again. The doctor told the husband that the patient only had a few days to live, while the patient thought she would be leaving the hospital soon. She died shortly after. The couple had kids as well. The doctor should have looked out for the rights of the patient. If I have a condition, I would like to be informed of it, especially if there are measures I need to take to improve my condition. The doctor and the husband did not give the patient a chance to put her health in her own hands.

Those who are responsible for the care of patients must understand the importance of honesty. It is better to be honest than to allow a patient’s health to be jeopardized, especially if a mistake has been made. Employees should feel comfortable informing their supervisors about the mistakes they have made. Employees should not feel that they have to cover up a mistake. Many times the mistakes can be corrected. Although in the case previously mentioned, the doctor did not make a mistake in not disclosing the patient’s condition, he had opportunities to inform the patient.

Autonomy was an ethical principle that was not recognized in this case. The patient was not given the opportunity to make her own decisions regarding her health because she was not aware of it. As mentioned previously the doctor was not honest with the patient regarding her condition. This made his acts unethical and immoral.

Health care administrators should demonstrate the behavior they expect of their employees. If they expect their employees to be honest, they should be honest as well. Employees should also have someone they can confide if they have displayed dishonesty, so that the problem can be corrected. Health care administrators must also educate employees on what could be considered dishonesty, even if it is a small case because ultimately the health care facility is responsible. Employees should also feel assured to report any acts of dishonesty that may be witnessed. If these messages are reiterated to employees, they will understand the seriousness of dishonesty and how it can affect the care given to patients.

Reference

Pozgar, George. (2005). Legal and ethical issues for health professionals. Jones & Bartlett Pub.

Unethical Behavior by Doctors

As I was browsing the internet, I stumbled across this article about medical students who felt they were pressured into acting unethically ("Study shows unethical," 2010). Researchers gathered information from Canadian medical students for the study. Some of the students saw their professors acting unethically and felt they should do the same. More than half of the students surveyed either felt pressured into acting unethically or saw their professors acting in this manner ("Study shows unethical," 2010). Students also stated that they did not feel comfortable approaching professors about ethical issues.

I found this article very disturbing. Physicians are viewed as leaders in the health care industry and it is sad when they are taught in medical school unethical behaviors. Although this study was conducted in Canada, there could be many other medical students who feel the same throughout the world. If physicians see this unethical behavior repeatedly, it may become a habit. They could also begin to think that this behavior is acceptable, especially if those they respect and learn from are displaying this behavior.

This is a very difficult situation for health care administrators. Physicians are a very critical part of our health care system and the information we receive from them is often considered valuable. Some of the unethical behaviors of physicians may be ignored if they are displaying it on a regular basis. Over time, these ethical dilemmas may be viewed as normal, especially if they are seeing this in medical school. For example, if a physician learned an unethical behavior during medical school and has been practicing medicine for 35 years, this behavior may have become a habit. If the physician is confronted, they may not think that they did nothing wrong.

As health care administrators, it is important that employees are frequently reminded of ethical standards and Code of Ethics. This can assist the administrators in educating the staff on what behaviors are considered unethical. It would also be appropriate to reeducate new physicians on ethical standards so that they are aware of what is expected of them when they begin practicing. In health care, sometimes it seems that physicians are exempt from certain standards because of their positions, but with ethics no one should be exempt.

Employees, including physicians, should feel comfortable speaking with someone regarding ethical issues. If they are struggling with the understanding what the ethical standards are, someone should be available for them. Having someone available and reeducating employees on ethical standards may prevent ethical dilemmas in the future. It is imperative employees understand and adhere to the standards of the facility in which they work. They must also fully understand the Code of Ethics and administrators should take the initiative to ensure these codes and standards are effectively communicated. They are not adhering to ethical principles and morals when employees ignore ethical standards. They could potentially harm fellow employees and patients.

Reference:

Study shows unethical behavior by doctors. (2010, March 22). Retrieved from http://abcnews.go.com/Health/story?id=117549&page=1

Health Care Fraud

Fraud is an ethical topic that is very common these days. There are many stories pertaining to health care fraud, but there was one that caught my interest. I enjoy watching documentaries because they give me information about significant stories that happened when I was younger or did not understand when they were developing at the time. There was a documentary about a podiatrist practicing in Nassau County, New York. A couple of years ago, a doctor was accused of billing Medicaid and Medicare for patients who were dead ("DA arrests jericho," 2008). The doctor was also creating charges for patients who had only seen him once. He was reporting to Medicare and Medicaid that he had seen these patients on several occasions. He was even billing Medicaid and Medicare for patients he never seen before. The podiatrist got away with this for 18 months.

It seems that this has not been the only case in which health care providers are billing third party payers for patients who are no longer living. Not only is this behavior illegal, but it is also unethical. The activity these providers are participating in, affects many people. It affects the patients, the payers, and the families of the victims. If I found out that a health care professional was using a deceased relative’s information to gain profits, it would saddened and upset me. I would ensure that this was reported immediately.

As health care administrators must make every attempt to ensure employees are not participating in fraudulent behavior. This could come in various forms such as accepting bribes, double charging and others. Fraud does not benefit anyone and could pose harm to many people. Causing harm is not considered an ethical principle. One of the duties of the health care administrator is to reinforce ethical principles and standards to the employees. This expresses the seriousness of ethics to employees.

Additionally the administrators can explain the consequences behind participating in fraud which could hopefully decrease the likelihood that employees will partake in the behavior. The Nassau County podiatrist was able to bill Medicare and Medicaid himself and did not have an executive monitoring his actions, therefore he was able to get away with it until the government got involved. This is a step that health care administrators want to avoid. Therefore, educating employees is essential in terms of ethical dilemmas.

I enjoy expressing which ethical principles or morals that were violated in each case. Although it would seem that professionals should know why certain actions are unethical, sometimes it is hard to determine that. In the case of this podiatrist, autonomy was violated because patients were not able to make their own decisions regarding the billing because they were unaware that their information was being used. The podiatrist also did not demonstrate beneficence, he actions were not representative of “doing good”. The podiatrist was also not being conscientious or honest in this case.

Having “morals” is an aspect of life that people assume others have, but in cases like these, it is safe to assume that not everyone has the same morals and ethical principles.

References

Da arrests jericho doctor. (2008, March 21). Retrieved from http://www.antonnews.com/syossetjerichotribune/2008/03/21/news/

Quality Blog #2: Medical Errors

Medical errors cause many injuries and deaths each year. According to the Agency for Healthcare Research and Quality, nearly 1 in 25 hospital patients are subjected to injuries caused by medical errors each year (AHRQ, 2000). The agency also estimates that 48,000-98,000 die annually from medical errors. This topic is an important one in terms of health care quality. This is true because if medical professionals are making errors that increase the infection rate in health care facilities and these errors are causing deaths, this is definitely not an example of health care quality. These deaths are preventable and health care workers have to take additional measures to ensure the health of the patient is not jeopardized due to their error. Medical errors reduce the quality of care given to patients.

The safety of the patient is essential in health care facilities. Patients are trusting health care professionals to improve their health. It makes some health care workers appear untrustworthy and incompetent when patients are becoming sicker while in the care of medical staff due to error. Both clinical and administrative have the responsibility of ensuring patients are safe and to reduce medical error. According to the AHRQ, there are steps that health care organizations can to improve the quality of care given to patients.

Some of the steps that can assist with reducing errors include investing in computer systems like Electronic Medical Records, which helps to catch errors faster than the human eye1(AHRQ, 2000). AHRQ also suggests that sending reminders for follow up tests helps with quality and reduces error. Health care organization should also establish some type of protocol to reduce errors.

This topic is really important to me because these deaths and injuries are preventable. Health care organizations have to make more attempts to reduce medical errors in an effort to increase quality. If facilities can reduce the number of injuries and deaths associated with medical errors, they are able to improve care given to patients. It is saddening when patients are subjected to injuries in a facility that is supposed to improve their health. As a future health care administrator, it is important that I take the initiative to reduce medical errors and improve quality. This is an issue that I have realized is important to me.

Reference:

Reducing Errors in Health Care: Translating Research Into Practice. AHRQ Publication No. 00-PO58, April 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/errors.htm

Racial Discrimination in Washington's Physician Offices

Ethical dilemmas are plentiful in the health care industry. We are in an industry where decision making is critical because decisions can determine the outcome of someone’s health and life. Therefore, it is important to acknowledge the significance of ethical decisions in health care. Racial discrimination still occurs in every aspect of our society and in all industries. In terms of discrimination, it occurs in the health care industry as well. After reading an article about research conducted in the state of Washington about African American patients being discriminated against, I felt this would be an appropriate ethical topic for this blog.

In health care there have been allegations of racial discrimination against patients as well as staff. For instance in research conducted in Washington, many patients felt they were not receiving the same care as other patients and were treated differently because of their ethnicity. The study was based mostly on African American patients.

Discrimination is an ethical issue that health care administrators have to address, regardless of their own prejudice. Racial discrimination can easily become a legal issue depending on the case. Therefore it is important for staff and administration to understand the ethics behind discrimination. In the study conducted by the state of Washington many patients decided to keep quiet about the discrimination they were facing in fear of not receiving treatment from that physician's office.

Patients should not be discriminated against because of their race. Minority patients should feel that they are really fair and quality services like everyone else. They should not feel afraid to speak up about the discrimination they faced. The administrators in these health care facilities should teach their staff about the importance of equality and treating every patient with dignity and respect. As stated previously an administrator needs to be able to set aside their own prejudices to provide care to the patients.

If they are not able to convey this message properly, they can consult with an outside agency that can educate the staff on ethics and discrimination to improve the care given to these patients. Although ethics is a subject that can become debatable because not everyone considers the same principles as being ethical, one should be able to determine that discrimination is not an ethical practice. Justice is an ethical principle that has been greatly disregarded in this case because they are not treating all patients similarly. There are also moral values that have been compromised in which they are limiting their compassion, conscientiousness, fidelity, and fairness due to the race of the patient.

Overall, the employees who were involved in discriminating should be reintroduced to the facility’s ethics policy and ensure quality is given to each patient.

Tuskegee Syphilis Study

The Tuskegee Syphilis Study is an ethical dilemma that happened decades ago, but it is still an issue that I find very disturbing. Over the span of 40 years, men in Tuskegee who had syphilis were told they would be given treatment by a group medical staff. The medical staff put them through a lot of painful and unnecessary treatments. They were never told that these were placebos and that these treatments would not help their syphilis. Many of the men died as their illness got progressively worse.

This practice was occurring amongst African American men who had syphilis. The researchers wanted to study the effects of this illness if it goes untreated. The patients were not told that there was currently a cure for syphilis. Yet the researchers put them through several harmful acts. One can assume they chose these men because they lived in rural areas and the chances of them finding out there was a cure for syphilis were lessened.

These acts and this study took place for 40 years before it was ended. It is hard to understand how this was allowed to happen for so long. Many of the patients died when their deaths could have been prevented with a simple procedure of receiving penicillin. It is unbelievable and unethical that this happened to these men. Most of the patients were African American and impoverished men in a rural community. As a result of this study, many African Americans have been afraid to participate in studies believing it will become a repeat of the Tuskegee Syphilis Study. Health care morass took place in the African American community in which they lost trust in the health care system.

There were several ethical principles that were not taken into account during this study. These principles include beneficence, nonmaleficence, and justice. The leaders in this study did not display any moral values as well. They did not have any compassion for the patients or conscientiousness. They were not fair or honest either. These are just a few of the ethical issues that occurred during this study and do not include any legal issues. It saddens me to know that health care leaders and researchers did not stop this and many men lost their lives for no reason.

South Florida Nurse Cause Harm to Hundreds of Patients

Last year there was a nurse in South Florida who was accused of reusing IV bags on multiple patients. There were nearly 2,000 she exposed to several infectious diseases such as TB, HIV, hepatitis and other diseases. The nurse had been a nurse for multiple years, and it is unknown if she had done this in previous years. This case shows many ethical dilemmas because she put the health of the patients at risk. Health care providers are taught to give the best care to patients and in this case she did not.

If she was worried about the lack of supplies, this should have been an issue she could have addressed with her manager. She should not have taken into her own hands to manage the supplies. This jeopardized the health of her patients and her actions made it seem as if the hospital was not producing quality care.

In health care ethics, one of the principles is nonmaleficence which is to avoid causing harm to patients. Nonmaleficence is a standard in the health care industry. In this case, the caregiver caused harm to many patients and exposed them to many deadly infections. She did not “avoid” causing harm to patients. This principle is important is all aspects of the health care industry. The health care system is used by patients to help with the improvement of their health. Patients should not leave a facility feeling as if they have been harm in some kind of way. The patients were not informed of the nurse’s actions until several months later, because that’s when the hospital were informed of it.

Another ethical principle that was questioned is beneficence requires doing good and helping others. In this matter, the nurse did not help others and her behavior is not labeled as doing good. If there was an issue with supplies, this should have been noted and expressed to her superiors. She did not help the patients, coworkers and other hospital staff by not mentioning to them what she was doing.

The health care administrators ensured that the patients were exposed were informed and requested they return for testing of infectious diseases that they could have been exposed to. Administrators could also review the ethics policy with the employees to ensure that they are aware of what is expected of them. This case cost the hospital a lot and reviewing the principles and standards of the hospital could reduce the risk of this happening again.