Teaching a less obvious medical skill -- Ethical decision-making

When medical students at the University of Iowa Roy J. and Lucille A. Carver College of Medicine learn about ethical decision-making in patient care, one of the things they paradoxically learn is that an "ethical" problem often isn't one.

Doctors routinely learn specific skills from textbooks, multimedia tools and hands-on training -- from diagnosing rare disorders to honing surgical techniques using state-of-the-art instruments. Ethical decision-making can be unsettling to medical students, who are accustomed to seeking out the single correct answer to any question.

And while many people consider a doctor's degree or specialty when choosing a physician, patients rarely wonder how their doctor makes ethical decisions.

Yet a physician's ability to reason ethically can contribute substantially to both the patient-physician interaction and health care delivery, said Lauris Kaldjian, M.D., Ph.D., an assistant professor of internal medicine who teaches second-year medical ethics at the UI Carver College of Medicine.

In an article that appeared online Feb. 9 in the Journal of General Internal Medicine, Kaldjian outlines the training approach developed by himself and two co-authors, Robert Weir, Ph.D., the Richard M. Caplan Endowed Chair in Biomedical Ethics and Medical Humanities at the UI, and Thomas P. Duffy, M.D., professor of internal medicine at the Yale University School of Medicine.

Titled "A Clinician's Approach to Clinical Ethical Reasoning," the article reveals how doctors can be effective in situations involving difficult decisions and differences in judgment.

"One of the challenges in clinical medical ethics is that sometimes a problem arises, and health care professionals believe they have an ethical problem on their hands. In fact, they may not; it may be a problem of communication or trust or insufficient medical information," said Kaldjian, who also is a staff ethicist for UI Hospitals and Clinics.

Contact: Becky Soglin
University of Iowa

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