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Is your doctor’s behavior unethical or unprofessional?

By Catherine DeAngelis

Photo by Mercy Health, CC BY 2.0, via Flickr.
Doctors and residents working with patients at the JFK clinic in St. Louis. Photo by Mercy Health, CC BY 2.0, via Flickr.
During a difficult operation on a patient, a surgeon is handed the wrong instrument by the nurse assisting him. He screams at the nurse, “You gave me the wrong thing,” and throws the instrument across the room. The nurse immediately hands him the correct instrument, but she feels humiliated and the rest of the surgical team become anxiously fearful of another outburst. This scene is repeated all too often in hospitals, and the anxiety provocation in members of the health care team can lead to poor patient care. Is such behavior unethical or unprofessional — and is there any real difference between the two?

At some point in his or her life, virtually every person will require the care or assistance of a health professional. It is reasonable to expect that physicians, nurses, and all others who contribute to health care, will act professionally. Note that I did not say ethically, but professionally; for example, the behavior of the surgeon cited above was not unethical, but certainly unprofessional. Physicians are capable of acting unprofessionally, but cannot act unethically, as ethical standards are part of their profession. Therefore, it behooves all patients to educate themselves on what constitutes “professional” and “unprofessional” behavior for those involved in health care.

First, consider that it takes a team to care for patients, and that not all team members are considered members of the same profession. For instance, almost everyone can identify physicians and nurses as health professionals, but many other health team members also belong to different professions that have different professional standards. Others members of the team can include physicians, nurses, public health practitioners, dentists, pharmacists, social workers, lawyers, clergy, economists/businesspersons, and ancillary service persons, such as those who provide nutrition and maintenance of the environment (can you imagine a clinical setting without a maintenance group to assure cleanliness and functioning of the equipment?).

It is critical for patients to distinguish between differing standards of professionalism, depending on the specific health team member involved in their care. This enables patients to have reasonable expectations for the way they should be treated by health professionals – before, during and after their treatment. But how many real or potential patients actually know the professional standards of those who will care for them? Probably very few, although most have expectations for how they believe a health professional should behave. Most people would probably have some idea of the Hippocratic oath for physicians, but not many actually have read it and understand what it means. Similarly, most have heard of Florence Nightingale, but few know about how she laid the foundation for professional nursing and that a Florence Nightingale Pledge exists.

It is safe to conjecture that the vast majority of individuals know more about what to expect before buying a car than they do about putting their lives in the hands of health care professionals. However, since your life is certainly worth more than any other possession, why not take the time and effort necessary to know each health team member’s standards of professionalism?

Dr. Catherine D. DeAngelis is University Distinguished Service Professor Emerita, professor of pediatrics emerita at the Johns Hopkins University School of Medicine and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. She served as the editor in chief emerita of JAMA, The Journal of the American Medical Association, and is the author of Patient Care and Professionalism.

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Recent Comments

  1. KGray

    Good article.

  2. Aidan O'Donnell

    I have witnessed incidences of the type you describe. Previously powerless, I would now consider such an outburst unacceptable. In my hospital, the surgeon would be officially reprimanded later for such behaviour, and it is likely, even at the time, that it would be made unmistakeably plain that throwing instruments is not OK.

    What makes this sort of thing difficult is that the surgeon may be the model of charm whenever there is a patient nearby. That doesn’t make the outburst OK, just because the patient is asleep at the time.

    Your next point concerns ethics. Professional standards do indeed (rightly) incorporate firm rules of ethics, but it is quite possible for doctors to act unethically, without necessarily violating their professional standards. A patient who is tube fed, but retains ethical capacity, might refuse further feeding. Knowing it will cause their eventual death by starvation, they still refuse, feeling that life has no meaning. The doctor has a conflict of ethics: a duty to support life, and a duty not to provide treatments the patient refuses. One doctor might consider that the ethics of this case demand compliance with the patient’s wishes. Another might consider that overruling the patient and feeding them against their wishes is the right thing. Both doctors, after very careful deliberation, believe they are doing the right thing, but you could find observers on either side who would argue that each is behaving unethically.

    Finally, the Hippocratic Oath. I did not take it, instead taking a modified Oath of Geneva, based on human rights. In fact, practically nobody is expected to take the original Hippocratic Oath any more. The oaths which doctors take are (basically) symbolic; the wording varies depending where you graduate, and to my knowledge they have no validity in law. Instead (and correctly, IMHO), professional guidelines are produced by bodies such as the Medical Council of New Zealand, which provides ongoing guidance about my professional behaviour. This has the advantage that they can be adjusted to cope with changing trends, such as the rise of social media networking.

    Nonetheless, your basic premise, that patients should inform themselves how their carers should (and should not) act, is rock solid.

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