How should the availability of personal information online, patient use of smartphones in the exam room and rapidly diversifying cultures in the patient population affect medical care and physicians’ professional ethics? Physicians are considering answers to these questions for inclusion in the AMA Code of Medical Ethics.
Physicians, residents and students provided insight into modern medical trends and their associated ethical issues in an Open Forum of the AMA Council on Ethical and Judicial Affairs (CEJA) during the 2015 AMA Annual Meeting in June.
Investigating patients online
In the age of social media and online publication, vast amounts of information about patients—including many minute details—are available within a matter of seconds. How much online research about a patient is appropriate for a physician, and how does it affect the patient-physician relationship?
Physicians asked the council to consider guidance on a wide array of nuanced issues tied to digital information and noted the dangers of what physicians might find.
Several physicians commented that looking for information beyond the clinical details available from the patient or health databases could deliver inaccurate information or details that could introduce bias into the patient’s care. At the same time, a little research on a patient could be a useful tool for improving care.
Medical situations could require a carefully balanced approach. For instance, one emergency physician posed a dilemma in which the physician suspects a patient of being a professional drug seeker. Is it the physician’s ethical obligation to do as much research as possible to determine how best to handle the situation to ensure the patient does not receive medications or other treatment that could harm the patient or others?
Physicians have been discussing this issue in medical journals and elsewhere and now are looking for clear ethical guidance.
Defining cultural competency
Another pressing topic physicians identified for further examination and ethical guidance was cultural competency in patient care.
CEJA member Kathryn Moseley, MD, noted that the U.S. population is becoming much more diverse, but diversity of the physician population isn’t keeping pace. “A lot of us will be taking care of patients who are much different from us,” Dr. Moseley said.
She noted that while physicians should always provide the same standard of care, they also need to understand what helps and hinders them in taking care of patients from diverse populations.
Several physicians observed that cultural competency training often doesn’t go deep enough to really help physicians as they care for patients. Ethnic, racial, cultural, language and educational backgrounds all can play a role in what patients prioritize, how they make decisions and how they interact with their physicians.
“It’s about understanding how cultural factors affect how physicians and patients are able to arrive at the appropriate treatment,” one physician commented.
Questions raised included the role of family members in the exam room, how to overcome language barriers with patients who don’t speak English and the physician’s responsibility when patients come to them seeking to get rid of physical traits that are tied to their race or ethnicity.
Modernizing the Code of Medical Ethics
As the oldest code of professional ethics, the 168-year-old AMA Code of Medical Ethics is a living document. Ethical opinions are frequently added to keep up with emerging medical issues, and CEJA hosts semi-annual Open Forums to hear more from physicians about topics under consideration.
Over the past six years, the Code has been undergoing a more comprehensive update to help make it more accessible for physicians in their daily practice of medicine.
As part of this historic project, CEJA has reviewed ethical opinions for relevance, timeliness, clarity and consistency across topics and incorporated feedback from the medical community to produce an updated Code with a more intuitive chapter structure.
The proposed updates are under review, and AMA members will be able to view and comment on the latest draft. Watch AMA Wire® for details when it becomes available
