At a session on balancing professional and personal lives, residents opened up about their own difficulties. "Usually I discuss this when I meet with them for evaluations, but that's sort of threatening for them," he noted.
At a recent session on sexual harassment in medical school, the discussion became "extremely heated, almost like a psychotherapy session," he added.
All but 2 of the 11 women in the residency program, and one male resident, said they had been treated differently in medical school because of their sex, either in the form of bias or inappropriate behavior.
A discussion about the effect of pharmaceutical representatives on physician practice ultimately led to a new policy being implemented at the University of Cincinnati that limits contact between drug reps and residents.
Brown University also limits contacts and gifts from drug reps, but the same policies do not apply to attending physicians and doctors associated with the institution, Dr. Bercovitch noted, and "the residents rightly feel this is a double standard."
Examining the contradictions and ethical gray areas of medical practice fosters the critical thinking needed for ethical medical practice, Dr. Mutasim emphasized.
Ethical Concerns' Widening Reach
The first thing that comes to mind for many people when they think of ethical issues in medicine tends to be physicians' interaction with the pharmaceutical industryparticularly the acceptance of gifts or funding, and the disclosure of these relationships.
There are many more ethical issues that practicing physicians, residents, and medical students face on a daily basis that make good topics for teaching, Dr. Bercovitch said. These include:
▸ Informed consent.
▸ Patient autonomy.
▸ The dispensing of drug samples.
▸ Cosmetic dermatology.
▸ The dispensing of cosmeceuticals.
▸ Advertising.
▸ Coding and billing issues.
▸ Management of children and other vulnerable populations.
▸ Privacy and confidentiality of medical records.
▸ Physician mental health and substance abuse.
▸ Management of medical errors.
▸ Treatment of sexually transmitted diseases.
▸ Management of emancipated minors.
▸ The trainee's role with superiors and subordinates.
▸ Ethics of the residency match system.
▸ Research ethics.
▸ Publication issues for writers, reviewers, and editors.
▸ Gene testing and gene therapy.