General practitioner perceptions of ethics in clinical practice

http://www.ncbi.nlm.nih.gov/pubmed/23210125

Aust Fam Physician. 2012 Dec;41(12):981-4.

The informal curriculum - General practitioner perceptions of ethics in clinical practice.

Sturman NJ, Parker M, van Driel ML.

Abstract

Australian medical students should graduate with an understanding of medical law and ethics, and be prepared for 'ethical decision making within the context of an appreciation of ethical issues related to human life and death'. The informal curriculum of inter-personal learning in clinical environments is likely to be more important in the process of moral enculturation of students than formally structured medical student teaching in the domain ofethics.

BACKGROUND:

Australian medical students should graduate with an understanding of the principles of medical law and ethics, and their application to clinical settings. Although student perspectives have been studied previously, the teacher experience of ethical issues also needs to be understood, particularly in the general practice setting.

METHODS:

Interviews were conducted with a convenience sample of 13 general practitioner teachers. They were asked to reflect on common and/or important ethical issues in their day-to-day practice. An inductive thematic analysis of the data was performed by two investigators, who reached a consensus on major themes using an iterative, dialogic process.

RESULTS:

Participants reported negotiating ethical issues frequently. Major themes included patient-doctor relationships, professional differences, truth-telling, ethically 'grey' areas and the personal demands of ethical decision making.

DISCUSSION:

General practitioners in this study describe sometimes needing to apply judgement and compromise in situations involving legal or ethical issues, in order to act in the best interests of patients and to successfully negotiate the patient-doctor relationship. Students learning in this clinical context may perceive mixed messages and ethical lapses in these challenging 'grey' areas. The ethical acumen and emotional resilience of both students and clinical teachers may be enhanced by ongoing reflective discussion with colleagues.