Medical house officers' knowledge, attitudes, and confidence regarding medical ethics

Article Abstract:

Ethical issues with which medical house officers (residents) must deal with include confidentiality, decisions not to resuscitate, and care of AIDS patients. However, the relationship between residents' training in ethics and their knowledge, attitudes, and confidence in ethics has not been well-studied. Training of residents is just beginning to address ethics, and it is important to evaluate the ways in which residents currently deal with ethical issues. Attitudes towards ethics were evaluated among 64 house officers who returned questionnaires. Part of this group had received six lectures on ethics, and part had also participated in case conferences addressing ethical issues. Before lectures, the residents were similar demographically, although one group reported a perception that medical school training in ethics was excellent. Lectures and case conferences were well received by residents. Knowledge on a test of ethics significantly declined in relation to duration of time since graduation but was positively associated with age and being Jewish. However, the group that received both lectures and case conferences had no relationship between years since graduation and knowledge about ethics. Residents who felt their previous ethics training was strong, those who received ethics lectures and case conferences, and those who were Jewish were more confident in dealing with ethical issues. Residents' attitudes on a variety of ethical issues did not correlate with confidence or knowledge. They were most apt to respect patients' autonomy when considering lying or withholding information, but less so when patient and physician disagreed as to decisions on medical treatment. The results of this and further research should be useful in modification of ethics training for house officers. (Consumer Summary produced by Reliance Medical Information, Inc.)

Beliefs, opinions and attitudes, Residents (Medicine), Medical ethics

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The development of academic programs for quality assessment

Article Abstract:

The term quality assessment refers to efforts by hospitals to assess and if necessary improve the quality of the care delivered. What care is delivered is influenced by a number of factors, including the cost of treatments, the demand by the public for the best and most complete care available, and the trend for both physicians and patients to demand nearly 100 percent certainty in diagnosis. Hospitals are organizing departments of quality assurance, often focusing on risk management, which largely involves the avoidance of lawsuits. Expanding the province of quality assessment departments might prove beneficial. The inclusion of a hospital epidemiologist, generally a clinician who studies trends in infectious illnesses, could bring a greater range of experience in analysis to a quality assurance team. Quality assessment should involve both clinical personnel and administrators. Quality assessment programs could be involved in the study of new technology before its incorporation into the routine of the hospital. Exposure of medical students and resident physicians to quality assurance issues early in their training would be a useful expansion of their curriculum, and of benefit to them in their future careers. A goal of quality assessment programs could be the differentiation between what is effective therapy and what is merely expensive therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical care, Quality management, Medical care quality, Quality control, Study and teaching, Hospitals, Hospital administration, editorial

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The accuracy of substituted judgments in patients with terminal diagnoses

Article Abstract:

Substituted judgments may not always accurately reflect the wishes of terminally ill patients. Substituted judgments are decisions about medical care made by the friends or family of the patient when the patient can no longer make them. Researchers interviewed 250 patients and their surrogate decision makers to assess the accuracy of the surrogates' judgment. Surrogate accuracy was 66% on average but varied depending on several factors. Accuracy was greater if the patient and surrogate had discussed end-of-life issues. Other factors were associated with less accurate judgment.

Analysis, Medical care decision-making authority (Law), Medical care decision making authority (Law), Judgment (Ethics)

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