Physicians and integrity – welcome to the prescient doc! highest level of education degree

As physicians, we carry out actions inconsistent with our beliefs. The longer we do this, the less integrated we are and the greater the threat to our well-being and lifestyle. We become increasingly adept at rationalizing our actions and obscuring the borders of our beliefs. Whether the motivation for doing this is internal or external, the outcome is the same – our integrity is compromised.

The physician is forced to make a choice – Do what is right or do what is easy. While it’s simple to say that you would always do what is right, patients will have unreasonable expectations, insurance companies will call you to question your documentation, your hospital will find you. You will be placed in situations where fear of malpractice will lead you to call consultants unnecessarily, order studies or do things that you don’t really feel are medically indicated.

This is in the context of a medical lifestyle that is already demanding your time and energy – it becomes very easy to do what is simple over what is right. And if these situations present themselves enough, the occasional lapse in integrity can become a trend and then a habit – all the while, the physician becomes adept at rationalizing why they’re doing the wrong thing, why it’s necessary.

We put distance between our medical knowledge and what we do for our patients. third level education It may be part of the culture of medicine for the physician to avoid critical conversations with patients. For example, we may see patients and feel that they have a clear responsibility for their condition but have a medical culture that promotes our avoidance of making this connection for the patient.

“Of the thousands of patients I have seen, only two or three have ever claimed to be unhappy: all the rest have said that they were depressed. This semantic shift is deeply significant, for it implies that dissatisfaction with life is itself pathological, a medical condition, which it is the responsibility of the doctor to alleviate by medical means. Everyone has a right to health; depression is unhealthy; therefore everyone has a right to be happy (the opposite of being depressed). hitler’s highest level of education This idea in turn implies that one’s state of mind, or one’s mood, is or should be independent of the way that one lives one’s life, a belief that must deprive human existence of all meaning, radically disconnecting reward from conduct. A ridiculous pas de deux between doctor and patient ensues: the patient pretends to be ill, and the doctor pretends to cure him. In the process, the patient is willfully blinded to the conduct that inevitably causes his misery in the first place.”

Our actions belie our thoughts and knowledge. Whether the action is avoiding a conversation with a patient for fear of being punished for it. or if it is unecessarily ordering tests, tests, medications or procedures – there’s what we know and then there’s what we do.

According to a study in Academic Emergency Medicine, (see summary article here or here), 97% of emergency physicians admitted to ordering imaging tests “in response to external pressures and not for optimal medical care.” External pressures included the fear of litigation or fear of missing low-probability diagnoses.

Another study, ( summary here) found that 20% of physicians admitted to providing unnecessary care. In this study, unnecessary care included testing, medications, procedures, admissions, specialty referrals, behavioral health therapy, use of durable medical equipment and more.

“Doctors cite reasons for limiting such exchanges and for not wanting to confuse patients, to cause unnecessary pain, or to eliminate hope. In such circumstances, the altruistic desire to do no harm may conflict with patient autonomy; it may be unclear whose feelings are actually being protected. In addition, physicians may lie to displace culpability for poor outcomes or to deny their ignorance or powerlessness to control disease processes.

Physicians also lie to respond to intense competitive pressures. Lying may help a physician avoid interpersonal or intrapsychic conflicts or difficult topics (eg, talking openly about disability or death). Prevarication may also represent an effort to encourage a particular treatment agenda. Sadly, there are also cases in which physicians exploit patients (eg, sexually or financially).” The Challenge

There is daily opportunity to do what is easy instead what is right. highest level of education survey Physicians are human and make the wrong the choice, thereby compromising their integrity. The physician can rationalize it in a number of ways – it’s easier, their hands are tied, it’s just a white lie, it’s better for the patient, etc. But on some level, you know it’s not right and the contrast between your actions and knowledge reflect back on you. If it happens occasionally, that’s one thing, but what happens to your mental health after doing this over the course of years?

Would it really matter whose fault it was? – Either way, your calories went up and you moved further from your goal. Ultimately, yes, it was you who chose to put the fork in your mouth but your partner really didn’t help you out much, did they? Consciously or not, your plans were sabotaged and you experience cognitive dissonance.

Over time, “it appears that extended exposure to cognitive dissonance ignites an initial emotional reaction that is then mediated by the rationalization process. If no rationalization can be made, or if the emotion cannot be effectively controlled by the individual, then the initial emotional reaction may grow more powerful, resulting in mood-regulation disorders such as depression, anxiety, or post-traumatic stress disorder.”

Mood dysregulation, anxiety, uncontrollable emotions – this sounds similar to physician burnout. Burnout is described in a number of ways – Christina Maslach described burnout as “an erosion of the soul caused by a deterioration of one’s values, dignity, spirit, and will.” Dike Drummond describes the trifecta of exhaustion, depersonalization and lack of efficacy.

Regardless of whether the reason is internal or external – habit, fear of litigation, patient requests, covering your bases, fear of malpractice, patient pressure or patient request – the dilemma exists. There is pressure to do things that you don’t feel are necessary and it is up to you to make the right decisions.

– Know this dilemma exists. Figuring this out part of the way through residency or years into practice is too late. As you go through medical education, you’re lulled into believing that these compromises are normal; they’re a part of medical culture. And indeed they are – but they weigh on you. Identifying early that you’re compromising gives you a chance to make the right decisions.

-Know that these dilemmas contribute to burnout. Feelings of uncontrolled emotions, mood dysregulation, and chronic stress overlap with burnout and chronic cognitive dissonance. The cumulative effect of longterm exposure is powerful and personal – watch out for it.

– Strive to understand yourself. Whatever your values are, develop clarity and know them. If you don’t have a sense of what your values are, you will not know if you are contradicting them. Being conscious of your values, your decisions and that these difficult situations are an opportunity for growth puts them in a different perspective.

-Communication: Learn how to talk to patients in a way that explains your thoughts and plans without being critical or harsh. Give them the treatment they need rather than acquiescing. Engage patients in their care plans, “shared decision making” and integrating education into your approach to

The development of integrity can be likened to dieting. average income by education level You cannot eat whatever you want and lose weight; you have to regiment it. Over time, you lose weight and achieve your goal. Or, over time,you get better with doing the right thing and become more integrated. Like in the chocolate cake analogy above – you need to know early that your partner is not going to support your diet – it’s your responsibility to keep the fork out of your mouth!