A medical ethics issues survey of residents in five pediatric training programs

Article Abstract:

Two arguments can be made for including training in moral and ethical issues for pediatric residents: the stressful nature of the residency, largely stemming from the immense responsibility associated with patient care; and the recent increase in medical lawsuits, fueled in part by poor communication between physicians and patients. In spite of the need for such education, few residency programs include training in ethics. To obtain information that could be useful for setting up curricula in ethics, an open-ended questionnaire was distributed to 51 residents at five medical centers or universities in the mid-south. Participants were residents in pediatrics or combined medicine-pediatric programs. The ethical dilemmas residents had faced most often in practice included: withdrawing care or withholding life support (57 percent and 9 percent, respectively); issues related to teenage pregnancy, birth control, and abortion (16 percent); the economic, legal, and social conflicts associated with medicine (9 percent); genetic counseling (4 percent); concerns about reporting abuse and neglect (4 percent); and balancing professional and family responsibilities (1 percent). The cases the residents cited as their most troublesome usually revolved around life-and-death issues; two thirds concerned withdrawing care from a neonate or child. The other one third of cases were those where a resident had to decide if a premature infant was viable, or where other decisions about newborn handicapped children had to be made. A large proportion of the respondents (71 percent) stated that their most troublesome case had not been fully resolved, for reasons they listed. Forty-one percent said they had sought assistance from another source in dealing with the case, most often from attending physicians. However, the respondents perceived assistance from their peers as more valuable than help from the attending physicians. The results provide helpful guidelines for developing a curriculum in medical ethics; most importantly, discussion of life-and-death issues would undoubtedly be welcome in residency programs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Training, Curricula, Medical colleges, Medical schools, Residents (Medicine), Medical ethics, Graduate medical education

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Parental alcoholism: a neglected pediatric responsibility

Article Abstract:

Many alcoholics are parents, yet the recognition and handling of this problem by pediatricians is poor. This fact is reinforced by information provided by Duggan and colleagues in the June 1991 issue of the American Journal of Diseases of Children. Pediatricians should do a better job in dealing with this problem; why don't they? Psychiatrists, general physicians, and surgeons are much more likely to recognize alcoholic parents than pediatricians and obstetricians. This may be due to lack of knowledge, discomfort, or the feeling that it is none of the pediatricians' business. This may be remedied if doctors were better educated on alcoholism in medical schools. Although many other topics and information must be covered, it is important to instill that alcoholism and alcohol abuse are medical problems, which often require physician involvement. Physicians should know that about 14 percent of the population is alcoholic, and one out of eight children has alcoholic parents. Parental abuse of alcohol affects children in many ways. Family life may be dysfunctional, ranging from nonsupportive to abusive. Drunk driving accounts for over 60 percent of highway deaths, which kill 8,000 children per year. Child abuse and fetal alcohol syndrome are other common consequences of parental drinking. Children of alcoholics are at high risk of becoming alcohol abusers. Major causes of death in adolescents and young adults, accidents, suicide, and homicide, are strongly related to alcohol abuse. Learning and emotional problems are also likely among adolescents who abuse alcohol. Physicians can easily learn to perform a quick screening test for alcoholism. Intervention by doctors, or referrals to programs, can be effective. With training, pediatricians and other physicians can overcome their discomfort and deal appropriately with alcohol abuse. It is up to pediatricians take responsibility for recognizing this important influence on children's health. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Social aspects, Diagnosis, Alcoholism, Family, Parent and child, Parent-child relations, Alcoholics, Children of alcoholics, editorial

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Effects of pediatrician characteristics on management decisions in simulated cases involving apparent life-threatening events

Article Abstract:

Non-medical factors appear to influence the clinical decisions of pediatricians when faced with a life-threatening event in an infant. Researchers surveyed 131 chief pediatric residents about simulated clinical cases. In an infant who stopped breathing, but currently appears healthy, 70% of pediatricians would order a home breathing monitor, and 40% would prescribe antibiotics for presumed infection. Fear of litigation caused 80% of the doctors to order more tests than necessary, and experience with a bad outcome in a similar case influenced the decision to use antibiotics.

Care and treatment, Apnea, Defensive medicine

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