A national survey of U.S. internists’ experiences with ethical dilemmas and ethics consultation

DuVal, Gordon; Clarridge, Brian; Gensler, Gary; Danis, Marion

doi:10.1111/j.1525-1497.2004.21238.x

Cited by 186 publications

(231 citation statements)

References 30 publications

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“…For example, a hospital ward with a hierarchic structure and unsupportive climate might have a different impact on this matter than a supportive work environment with a network of consistent boundaries regarding the psychosocial work climate. This is in line with previous research where physicians are shown to have different attitudes to and practice of confidentiality [19,20], their professional role [21,22] and coping strategies used to deal with ethical [23,24] and emotional [25] discomfort in their work. Based on the current results, these factors are likely to be associated with how physician manages emotionally-charged work situations and confidentiality.…”

Section: The Overlap Between Personal and Professional Relationshipssupporting

confidence: 91%

Exploring the subjective burden of confidentiality among physicians in Norway

Tevik¹,

Håkon²

2011

Health

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Background: Concern about protecting patient privacy is proposed to be a barrier for physiccians to talk about emotional distress from their professional experiences. This makes it difficult for many physicians to utilize and fully benefit from different network of social support. The subjective burden of confidentiality is reported to be associated with physician's health and wellbeing. Aims: To gain knowledge about factors in the in personal and professional sphere that can be associated with the subjective burden of confidentiality. Methods: Qualitative semistructured interviews with 14 general practitioners and hospital physicians in Norway. Examination of transcribed verbatim interviews using qualitative content analysis. Results: The subjective burden of confidentiality is likely linked with factors such as perception of professional role, social support from colleagues, partners and friends; size of patient population, organizational factors and work environment, and the overlap between personal and professsional relationships. Conclusions: Addressing the interaction of emotional demands and patient confidentiality is important to study successful coping with distress from physician's professional experiences.

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Section: The Overlap Between Personal and Professional Relationshipssupporting

confidence: 91%

Exploring the subjective burden of confidentiality among physicians in Norway

Tevik¹,

Håkon²

2011

Health

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“…Results from other studies show that experiences with ethical difficulties or moral distress routinely arise in the medical setting [26][27][28] . Results from a representative study of Norwegian physicians revealed that over 40% reported frequent occurrence of ethical problems at work 29) .…”

Section: Discussionmentioning

confidence: 96%

Confidentiality and Physicians' Health. A Cross‐sectional Study of University Hospital Physicians in Four European Cities (the HOUPE‐study)

Løvseth

Aasland

Fridner

et al. 2010

Journal of Occupational Health

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To investigate how the subjective burden of confidentiality can act as a stressor that affects physicians' psychological health and wellbeing. Method: Cross-sectional survey data from a sample of university hospital physicians (N=1,956) in four European countries (Sweden, Norway, Iceland and Italy) who participated in the HOUPE (Health and Organization among University hospital Physicians in Europe) study was analysed. Results: About 25% of the participants reported that confidentiality impedes emotional support to a considerable degree. An index of confidentiality as a barrier to seeking support (ICBS) had a negative effect on physicians' health and wellbeing. The effect of ICBS was confirmed and slightly increased when controlled for variables known to buffer the adverse mental and physical effects of stress. Though the physicians in Iceland and in Norway found confidentiality the most challenging, it was the physicians in Italy and Sweden who showed a significant effect of ICBS on their health and wellbeing. Conclusions: Whether confidentiality is a stressor in its own right or an amplifier of stressful situations in medical practice should be further investigated to gain a better understanding of the effect of confidentiality on physicians' coping, stress and health. In addition, there is a need to investigate how physicians can balance coping with the inevitable emotional demands of medical practice and maintaining the ethics of confidentiality in a way that protects both patients' privacy rights and physicians' health and wellbeing.

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“…Respondents were most concerned about situations that are known to be ethically and legally sensitive, such as end-of-life care, medical errors and patient privacy. [37][38][39][40][41][42] Patient autonomy appeared to be the most common source of concern. The five situations that were most commonly reported to be troubling were (in rank order) a patient refusing recommended treatment, disagreement among staff, a patient requesting a treatment of uncertain value, aggressive treatment of a terminally ill patient and a patient requesting treatment outside hospital guidelines.…”

Section: Discussionmentioning

confidence: 99%

Managing ethical issues in patient care and the need for clinical ethics support

Doran¹,

Fleming²,

Jordens³

et al. 2015

Aust. Health Review

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Objective. To investigate the range, frequency and management of ethical issues encountered by clinicians working in hospitals in New South Wales (NSW), Australia.Methods. A cross-sectional survey was conducted of a convenience sample of 104 medical, nursing and allied health professionals in two NSW hospitals.Results. Some respondents did not provide data for some questions, therefore the denominator is less than 105 for some items. Sixty-two (62/104; 60%) respondents reported occasionally to often having ethical concerns. Forty-six (46/105; 44%) reported often to occasionally having legal concerns. The three most common responses to concerns were: talking to colleagues (96/105; 91%); raising the issue in a group forum (68/105; 65%); and consulting a relevant guideline (64/105; 61%). Most respondents were highly (65/99; 66%) or moderately (33/99; 33%) satisfied with the ethical environment of the hospital. Twenty-two (22/98; 22%) were highly satisfied with the ethical environment of their department and 74 (74/98; 76%) were moderately satisfied. Most (72/105; 69%) respondents indicated that additional support in dealing with ethical issues would be helpful.Conclusion. Clinicians reported frequently experiencing ethical and legal uncertainty and concern. They usually managed this by talking with colleagues. Although this approach was considered adequate, and the ethics of their hospital was reported to be satisfactory, most respondents indicated that additional assistance with ethical and legal concerns would be helpful. Clinical ethics support should be a priority of public hospitals in NSW and elsewhere in Australia.

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A national survey of U.S. internists’ experiences with ethical dilemmas and ethics consultation

Cited by 186 publications

References 30 publications

Exploring the subjective burden of confidentiality among physicians in Norway

Exploring the subjective burden of confidentiality among physicians in Norway

Confidentiality and Physicians' Health. A Cross‐sectional Study of University Hospital Physicians in Four European Cities (the HOUPE‐study)

Managing ethical issues in patient care and the need for clinical ethics support

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