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AMA Journal of Ethics

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https://www.readbyqxmd.com/read/28323613/correction-to-the-case-of-dr-oz-ethics-evidence-and-does-professional-self-regulation-work
#1
Audiey C Kao
No abstract text is available yet for this article.
March 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28323612/from-particularities-to-context-refining-our-thinking-on-illness-narratives
#2
Annie Le, Kara Miller, Juliet McMullin
This paper examines how illness narratives are used in medical education and their implications for clinicians' thinking and care of patients. Ideally, collecting and reading illness narratives can enhance clinicians' sensitivity and contextual thinking. And yet these narratives have become part of institutionalizing cultural competency requirements in ways that tend to favor standardization. Stereotyping and reductionistic thinking can result from these pedagogic approaches and obscure structural inequities...
March 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28323611/the-role-of-universal-health-literacy-precautions-in-minimizing-medspeak-and-promoting-shared-decision-making
#3
Lara Killian, Margo Coletti
Shared decision making (SDM), a collaborative process whereby patients and professionals make health care decisions together, is a cornerstone of ethical patient care. The patient-clinician communication necessary to achieve SDM depends on many factors, not the least of which is a shared language (sometimes with the aid of a medical interpreter). However, even when a patient and clinician are speaking the same mother tongue, the use of medical jargon can pose a large and unnecessary barrier. This article discusses how health care professionals can use "universal health literacy precautions" as a legal, practical, and ethical means to enhance SDM and improve health care outcomes...
March 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28323610/strategies-for-acing-the-fundamentals-and-mitigating-legal-and-ethical-consequences-of-poor-physician-patient-communication
#4
MaryKatherine Brueck, Angelique M Salib
This article explores how the absence of effective verbal and nonverbal communication in the physician-patient encounter can lead to poor outcomes for patients and physicians alike. The article discusses legal and ethical topics physicians should consider during a medical encounter and provides educational and practical suggestions for improving effective communication between physicians and their patients.
March 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28323609/language-structure-and-reuse-in-the-electronic-health-record
#5
Angus Roberts
Medical language is at the heart of the electronic health record (EHR), with up to 70 percent of the information in that record being recorded in the natural language, free-text portion. In moving from paper medical records to EHRs, we have opened up opportunities for the reuse of this clinical information through automated search and analysis. Natural language, however, is challenging for computational methods. This paper examines the tension between the nuanced, qualitative nature of medical language and the logical, structured nature of computation as well as the way in which these have interacted with each other through the medium of the EHR...
March 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28323608/from-doctors-stories-to-doctors-stories-and-back-again
#6
Marcia Day Childress
Stories have always been central to medicine, but during the twentieth century bioscience all but eclipsed narrative's presence in medical practice. In Doctors' Stories, published in 1991, Kathryn Montgomery excavated medicine's narrative foundations and functions to reveal new possibilities for how to conceive and characterize medicine. Physicians' engagement with stories has since flourished, especially through the narrative medicine movement, although in the twenty-first century this has been challenged by the health care industry's business-minded and data-driven clinical systems...
March 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28323607/language-based-inequity-in-health-care-who-is-the-poor-historian
#7
Alexander R Green, Chijioke Nze
Patients with limited English proficiency (LEP) are among the most vulnerable populations. They experience high rates of medical errors with worse clinical outcomes than English-proficient patients and receive lower quality of care by other metrics. However, we have yet to take the issue of linguistic inequities seriously in the medical system and in medical education, tacitly accepting that substandard care is either unavoidable or not worth the cost to address. We argue that we have a moral imperative to provide high-quality care to patients with LEP and to teach our medical trainees that such care is both expected and feasible...
March 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28323606/when-and-how-should-clinicians-share-details-from-a-health-record-with-patients-with-mental-illness
#8
Robyn P Thom, Helen M Farrell
Stigma associated with mental illness-a public health crisis-is perpetuated by the language used to describe and document it. Psychiatric pathology and how it can be perceived among clinicians contribute to the marginalization of patients, which exacerbates their vulnerability. Clinical documentation of mental illness has long been mired in pejorative language that perpetuates negative assumptions about those with mental illness. Although patients have the legal right to view their health record, sharing mental health notes with patients remains a sensitive issue, largely due to clinicians' fears that review of this content might cause harm, specifically psychiatric destabilization...
March 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28323605/clinicians-obligations-to-use-qualified-medical-interpreters-when-caring-for-patients-with-limited-english-proficiency
#9
Gaurab Basu, Vonessa Phillips Costa, Priyank Jain
Access to language services is a required and foundational component of care for patients with limited English proficiency (LEP). National standards for medical interpreting set by the US Department of Health and Human Services and by the National Council on Interpreting in Health Care establish the role of qualified medical interpreters in the provision of care in the United States. In the vignette, the attending physician infringes upon the patient's right to appropriate language services and renders unethical care...
March 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28323604/why-it-s-unjust-to-expect-location-specific-language-specific-or-population-specific-service-from-students-with-underrepresented-minority-or-low-income-backgrounds
#10
Barret Michalec, Maria Athina Tina Martimianakis, Jon C Tilburt, Frederic W Hafferty
In this case we meet Amanda, a medical student of Native and Latin American ethnicity who receives financial aid. Her friends are surprised by her interest in an elite residency program. They suggest, rather, that with her language skills, ethnic background, and interest in social justice, she has a responsibility to work with underserved patient populations. In our commentary, we consider issues raised by the case and explore Amanda's friends' underlying expectations and assumptions that perpetuate the very inequities that the resolution of the case purports to address...
March 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28323603/how-medicine-may-save-the-life-of-us-immigration-policy-from-clinical-and-educational-encounters-to-ethical-public-policy
#11
Mark G Kuczewski
Medicine has a conceptual contribution to make to the immigration debate. Our nation has been unable to move forward with meaningful immigration reform because many citizens seem to assume that immigrants are in the United States to access benefits to which they are not entitled. In contrast, when medicine encounters undocumented immigrants in the health care or medical education setting, it is obvious that their contributions to our health care system are denied by exclusionary laws. When the system is amended to be inclusive, immigrants become contributors to the systems that they access...
March 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28225702/the-idea-of-legitimate-authority-in-the-practice-of-medicine
#12
Arthur Isak Applbaum
Legitimate authority is the normative power to govern, where a normative power is the ability to change the normative situation of others. Correlatively, when one has the normative power to govern others, these others face a normative liability to be governed. So understood, physicians do not have legitimate authority over their patients, and patients do not have legitimate authority over their physicians. An authority is legitimate only when it is a free group agent constituted by its free members. On this conception, associations of physicians sometimes have legitimate authority over individual physicians, and physicians sometimes count as members subject to the legitimate authority of these associations...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28225701/the-case-of-dr-oz-ethics-evidence-and-does-professional-self-regulation-work
#13
Jon C Tilburt, Megan Allyse, Frederic W Hafferty
Dr. Mehmet Oz is widely known not just as a successful media personality donning the title "America's Doctor(®)," but, we suggest, also as a physician visibly out of step with his profession. A recent, unsuccessful attempt to censure Dr. Oz raises the issue of whether the medical profession can effectively self-regulate at all. It also raises concern that the medical profession's self-regulation might be selectively activated, perhaps only when the subject of professional censure has achieved a level of public visibility...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28225700/seeking-legitimacy-for-dsm-5-the-bereavement-exception-as-an-example-of-failed-process
#14
James E Sabin, Norman Daniels
In 2013 the American Psychiatric Association (APA) published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Even before publication, DSM-5 received a torrent of criticism, most prominently over removal of the "bereavement exclusion" for the diagnosis of major depression. We argue that while the APA can claim legitimate authority for deciding scientific questions, it does not have legitimacy for resolving what is ultimately a question of ethics and public policy. We show how the "accountability for reasonableness" framework for seeking legitimacy in health policy could have been used to achieve a better resolution of the conflict than actually occurred...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28225699/what-is-the-relevance-of-procedural-fairness-to-making-determinations-about-medical-evidence
#15
Govind Persad
Approaches relying on fair procedures rather than substantive principles have been proposed for answering dilemmas in medical ethics and health policy. These dilemmas generally involve two questions: the epistemological (factual) question of which benefits an intervention will have, and the ethical (value) question of how to distribute those benefits. This article focuses on the potential of fair procedures to help address epistemological and factual questions in medicine, using the debate over antidepressant efficacy as a test case...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28225698/reasonableness-credibility-and-clinical-disagreement
#16
Mary Jean Walker, Wendy A Rogers
Evidence in medicine can come from more or less trustworthy sources and be produced by more or less reliable methods, and its interpretation can be disputed. As such, it can be unclear when disagreements in medicine result from different, but reasonable, interpretations of the available evidence and when they result from unreasonable refusals to consider legitimate evidence. In this article, we seek to show how assessments of the relevance and implications of evidence are typically affected by factors beyond that evidence itself, such as our beliefs about the credibility of the speaker or source of the evidence...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28225697/who-should-ration
#17
Philip M Rosoff
A principal component of physician decision making is judging what interventions are clinically appropriate. Due to the inexorable and steady increase of health care costs in the US, physicians are constantly being urged to exercise judicious financial stewardship with due regard for the financial implications of what they prescribe. When applied on a case-by-case basis, this otherwise reasonable approach can lead to either inadvertent or overt and arbitrary restriction of interventions for some patients rather than others on the basis of clinically irrelevant characteristics such as ethnicity, gender, age, or skin color...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28225696/what-to-do-when-there-aren-t-enough-beds-in-the-picu
#18
Michael A Rubin, Robert D Truog
The concepts of medical futility and rationing are often misunderstood and lead to significant consternation when resources are stretched and pediatric intensive care unit (PICU) beds are unavailable. While the two concepts overlap, each has its own distinct application and moral justification. Most importantly, we should avoid using one to justify the other. Bioethics professionals should assist critical care clinicians in clarifying when each rubric should be applied as well as how to develop policies to standardize the approach...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28225695/how-should-therapeutic-decisions-about-expensive-drugs-be-made-in-imperfect-environments
#19
Leonard M Fleck, Marion Danis
Clinicians must inevitably make therapeutic decisions under nonideal conditions. They practice in circumstances that involve incomplete evidence. They deliver care in health care systems that are complex and poorly coordinated. Each of the patients that they take care of is unique while research offers evidence regarding relatively homogeneous populations of patients. Under these circumstances, many parties-medical scientists, reviewing agencies, insurers, and accountable care organizations-can and should contribute to optimizing the development, approval, funding, and prescription of therapies-particularly expensive and marginally beneficial therapies...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28225694/polarities-in-clinical-thinking-and-practice
#20
John Z Sadler
This analysis of a case of a bereaved patient that poses two treatment options-watchful waiting or medication-focuses on five "polarities" in clinical practice: (1) the normal and the pathological, (2) the individual and the diagnostic collective, (3) the primary care physician and the consultant, (4) the expert and nonexpert, and (5) the moment and the process. These polarities can accentuate ethical problems posed by this case, for example, by creating stark contrasts that mask the complex contexts of care and characteristics of patients...
February 1, 2017: AMA Journal of Ethics
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