ABSTRACT
The patient-centered medical home (PCMH), with its focus on patient-centered care, holds promise as a way to reinvigorate the primary care of patients and as a necessary component of health care reform. While its tenets have been the subject of review, the ethical dimensions of the PCMH have not been fully explored. Consideration of the ethical foundations for the core principles of the PCMH can and should be part of the debate concerning its merits. The PCMH can align with the principles of medical ethics and potentially strengthen the patient-physician relationship and aspects of health care that patients value. Patient choice and these ethical considerations are central and at least as important as the economic and practical arguments in support of the PCMH, if not more so. Further, the ethical principles that support key concepts of the PCMH have implications for the design and implementation of the PCMH. This paper explores the PCMH in light of core principles of ethics and professionalism, with an emphasis both on how the concept of the PCMH may reinforce core ethical principles of medical practice and on further implications of these principles.
Subject(s)
Patient-Centered Care/ethics , Primary Health Care/ethics , Ethics, Medical , Health Care Reform/ethics , Health Care Reform/organization & administration , Humans , Patient-Centered Care/organization & administration , Physician-Patient Relations , Primary Health Care/organization & administrationABSTRACT
Medicine, law, and social values are not static. Reexamining the ethical tenets of medicine and their application in new circumstances is a necessary exercise. The sixth edition of the American College of Physicians (ACP) Ethics Manual covers emerging issues in medical ethics and revisits older ones that are still very pertinent. It reflects on many of the ethical tensions in medicine and attempts to shed light on how existing principles extend to emerging concerns. In addition, by reiterating ethical principles that have provided guidance in resolving past ethical problems, the Manual may help physicians avert future problems. The Manual is not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared duties of the medical profession.
Subject(s)
Ethics, Medical , Manuals as Topic , Patient Care/ethics , Biomedical Research/ethics , Humans , Interprofessional Relations/ethics , Physician-Patient Relations , Social Responsibility , Terminal Care/ethics , United StatesABSTRACT
The AMA Council on Ethical and Judicial Affairs (CEJA) has initiated an important discussion on medical professionalism and the use of social media by issuing thoughtful and practical guidance for physicians and medical students. The implications of online activities for trust in the profession, as well as for trust between patient and doctor, however, will need further exploration as digital life expands and evolves.
Subject(s)
Internet , Physician-Patient Relations/ethics , Physicians/ethics , Practice Patterns, Physicians'/ethics , Social Environment , Trust , Advisory Committees , American Medical Association , Ethics, Medical , Guideline Adherence , Humans , Internet/ethics , Liability, Legal , Personal Autonomy , Professional Autonomy , United StatesSubject(s)
Ethics, Clinical , Ethics, Medical , Manuals as Topic , Physician's Role , Prisoners , Government , Social Responsibility , Societies, Medical , United StatesSubject(s)
Clinical Trials as Topic/ethics , Conflict of Interest , Drug Industry , Ethics, Clinical , Ethics, Medical , Ethics, Research , Office Visits , Clinical Trials as Topic/economics , Drug Industry/ethics , Drug Industry/trends , Ethical Review , Humans , Internal Medicine/ethics , Multicenter Studies as Topic/ethics , Physician-Patient Relations/ethics , Reimbursement Mechanisms , Research Design , Research Support as Topic , Researcher-Subject Relations/ethics , TrustABSTRACT
Pay-for-performance programs are growing, but little evidence exists on their effectiveness or on their potential unintended consequences and effects on the patient-physician relationship. Pay-for-performance has the potential to help improve the quality of care, if it can be aligned with the goals of medical professionalism. Initiatives that provide incentives for a few specific elements of a single disease or condition, however, may neglect the complexity of care for the whole patient, especially the elderly patient with multiple chronic conditions. Such programs could also result in the deselection of patients, "playing to the measures" rather than focusing on the patient as a whole, and misalignment of perceptions between physicians and patients. The primary focus of the quality movement in health care should not be on "pay for" or "performance" based on limited measures, but rather on the patient. The American College of Physicians hopes to move the pay-for-performance debate forward with a patient-centered focus--one that puts the needs and interests of the patient first--as these programs evolve.
Subject(s)
Patient-Centered Care/ethics , Patient-Centered Care/standards , Reimbursement, Incentive/ethics , Humans , Physician-Patient Relations/ethics , Quality of Health CareSubject(s)
Conflict of Interest , Drug Industry , Ethics, Medical , Gift Giving , Physicians/standards , Humans , United StatesABSTRACT
Many physicians and health care leaders express concern about the amount of time available for clinical practice. While debates rage on about how much time is truly available, the perception that time is inadequate is now pervasive. This perception has ethical significance, because it may cause clinicians to forego activities and behaviors that promote important aspects of the patient-physician relationship, to shortcut shared decision making, and to fall short of obligations to act as patient advocates. Furthermore, perceived time constraints can hinder the just distribution of physician time. Although creating more time in the clinical encounter would certainly address these ethical concerns, specific strategies-many of which do not take significantly more time-can effectively change the perception that time is inadequate. These approaches are critical for clinicians and health systems to maintain their ethical commitments and simultaneously deal with the realities of time.
Subject(s)
Communication , Ethics, Clinical , Physician-Patient Relations , Time Management , Attitude of Health Personnel , Humans , Office Visits , Practice Management, Medical/ethicsABSTRACT
Medicine, law, and social values are not static. Reexamining the ethical tenets of medical practice and their application in new circumstances is a necessary exercise. The fifth edition of the College's Ethics Manual covers emerging issues in medical ethics and revisits old ones. It reflects on many of the ethical tensions faced by internists and their patients and attempts to shed light on how existing principles extend to emerging concerns. In addition, by reiterating ethical principles that have provided guidance in resolving past ethical problems, the Manual may help physicians avert future problems. The Manual is not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared obligations and duties of the medical profession.
Subject(s)
Ethics, Clinical , Ethics, Medical , Manuals as Topic , Biomedical Research/ethics , Decision Making , Ethics, Professional , Physician-Patient Relations/ethics , Social Responsibility , Terminal Care/ethicsABSTRACT
Cost pressures and changes in the health care environment pose ethical challenges and hard choices for patients, physicians, policymakers, and society. In 2000 and 2001, the American College of Physicians, with the Harvard Pilgrim Health Care Ethics Program, convened a working group of stakeholders--patients, physicians, and managed care representatives, along with medical ethicists--to develop a statement of ethics for managed care. The group explored the impact of a changing health care environment on patient-physician relationships and how to best apply the principles of professionalism in this environment. The statement that emerged offers guidance on preserving the patient-clinician relationship, patient rights and responsibilities, confidentiality and privacy, resource allocation and stewardship, the obligation of health plans to foster an ethical environment for the delivery of care, and the clinician's responsibility to individual patients, the community, and the public health, among other issues.
