Professional Misconduct In The Medical Domain

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Professional Misconduct In The Medical Domain

• By Sylvia Mal and Ayla Mittelholtz

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Definition

• Medical Malpractice
• An act or omission by a health care provider
  which deviates from accepted standards of
  practice in the medical community and which
  causes injury to the patient

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Statistics

• Up to 100,000 US patients die each year because
  of preventable adverse effects
• Proportion of hospitalized patients affected by
  medical errors estimated to be 5-10 - it has
  approached 50 in some studies
• Mizrahi found that 47 of internal medicine
  residents reported making serious errors during
  their training

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Techniques of NeutralizationSykes and Matza
(Thio)
1. Denial of Responsibility
2. Denial of Injury
3. Denial of the Victim
4. Condemnation of the Condemners
5. Appeal to Higher Loyalties
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Denial Of Responsibility

• The act is justified because the individual has
  no control over it

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Denial Of Injury

• Individuals claim that no one was harmed so
  nothing deviant or wrong has occurred

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Denial Of The Victim

• The individual argues that whoever is harmed by
  the deviance deserves the harm

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Condemnation Of The Condemners

• The Individual claims that those who disapprove
  of the act are hypocrites who have done much
  worse

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Appeal To Higher Loyalties

• The individuals attachments to norms other than
  those of the larger society hold preeminence

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Four Models of the Physician-Patient
Relationship
1. The Paternalistic Model
2. The Informative Model
3. The Interpretive Model
4. The Deliberative Model
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The Paternalistic Model

• The physician-patient interaction ensures that
  patients receive the intervention that best
  promote their health and well-being
• Doctors try to find medical tests and treatments
  that are most likely to restore patients health
• Promoting the patients well-being independent of
  the patients current preferences

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The Informative Model

• The physician presents all relative information
  to the patient and the patient selects the
  medical intervention he/she wants

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The Interpretive Model

• Supplying relevant information
• Helps to define patient values by suggesting what
  medical interventions should be given

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The Deliberative Model

• Aim of the physician-patient interaction is to
  help the patient determine and choose the best
  health related values
• Physician and patient engage in deliberation on
  what kind of intervention should take place
• Physician is seen more as a friend

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5th Model of Physician-Patient ModelThe
Instrumental Model

• The patients values are irrelevant
• The physician aims for some goal independent of
  the patient
• E.g. Furtherance of scientific knowledge
  (Tuskegee syphilis experiment)

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Trust

• Trust provides moral foundation for any
  physician-patient relationship
• There is a need for patients to trust their
  physicians because of the knowledge gap that
  exists between them
• Society tends to trust physicians to understand
  the need to respect patients and act in their
  best interest

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Informed Consent

• Seen as not merely a legal requirement and not
  merely a formality it is a substantial
  requirement of morality (Baylis et al., 2004)
• Medically valid consent includes giving the
  patient all the information required in order to
  make a responsible decision

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Misdiagnosis Case

• Darrie Eason Misdiagnosed with cancer
• Because of mislabeled tissue sample that led to a
  misdiagnosis, Darrie had both of her breasts
  removed to save her from a cancer that she never
  had

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Surgical Errors

• A second major issue within medical malpractice
  is when patients leave the hospital with surgical
  instruments inside them
• Some studies have discovered that leaving
  instruments inside people is more likely to
  happen under stressful situations such as
  emergency operations
• It is believed that there could be many cases
  that never get reported because patients never
  find out and are unaware of the medical mistake

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Surgical Errors - Case

• Victor Hutchinson
• 76 year old
• Father of five
• Heart bypass surgery in September 2003

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Theoretical Perspectives

• Labeling Theory (Gomme Chapter 6)
• Patients who enter medical hospitals and
  especially mental hospitals tend to be
  stigmatized into a deviant sick role
• Throughout the process of stigmatization patients
  gain a notion of having a master status of a sick
  person
• With this master status comes a feeling of
  dependency on doctors and health care providers

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Theoretical Perspectives

• Quinneys Conflict Theory (Gomme Chapter 8)
• 3 of the 6 propositions
• Crime is a definition of human conduct that is
  created by authorized agents in society
• Criminal definitions describe behaviors that
  conflict with the interests of the segments of
  society that have the power to shape public
  policy
• Criminal definitions are applied by the segments
  of society that have the power to shape the
  enforcement and administration of criminal law

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Theoretical Perspectives

• Functionalism Durkheim (Gomme Chapter 4)
• Crime is functional in society because it
  promotes solidarity, collective consciousness,
  and change
• When medical malpractice occurs it forces society
  to change the way the health care system is run
• It forces doctors of all kinds to be more
  cautious throughout all stages of medical
  intervention

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Medical Malpractice
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Discussion Questions

• In the Greys Anatomy clip, Dr. Burke is dealt
  with leniently, do you feel that this happens
  frequently when doctors make mistakes?
• Do you think there should be stricter protocols
  when medical errors occur?
• Do you feel that something should be done to
  break the physician-patient barrier? Do you feel
  doctors should be more attentive to their
  patients needs?