During the course of a patient's stay, the patient and/or family may request a change in provider related to a dissatifsying experience, complaint or a personal preference.  Provider is intended to be used in a broad sense and can include any associate providing service to the patient, ie physician, nurse, therapist.

Occasionally, the astute clinician may identify that the therapeutic relationship with the patient has either not been effectively established or has deteriorated.

What is the providers moral, ethical and professional obligation to honor the request or remove themselves and request reassignment?

Does a patient have the right to change providers for any reason?

Does the type of provider change the right or circumstance under which a change in provider should be honored?

Are there situations or events that would be exceptions to assigning a different provider?

I am interested in entertaining how other HCO have handled these request.  Our ethics committee is currently discussing this issue and we have found that there are varied and in some instances extreme differences in opinion.

Most of my staff including physicians are mission driven and most chose healthcare to heal, comfort and educate patients to a better health.  I find this mix leads to innate ethical decisions.  However some Board of Governors don't come close to ethical decision making. It is usually the farthest thing from their mind.  One board I previously worked with lacked any group semblance of ethical behavior.  Conflict of interest existed in most members, especially with the physicians that sat on the board. 

As CEO, this is a poisonous environment.  With unethical pressures from above, it is difficult to promot ethical behavior within the hospital.

This week's practice questions includes:

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10.  "The purpose of a "Living Will" is:

 a)   establish laws that define when life support measures are futile

b)    allow persons unable to communicate with caregivers to express their wishes about the extent of treatment they wish to have applied

c)    allow a person to take their own life if there is no hope for a productive life after  a long term illness

d)   allow a person to define the distribution of material wealth after die"

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The answer given was "A."  I think it should be "B".

Also,  #16 (To be legally liable, directors must have committed an act of gross negligence, usually defined as an intentional failure to perform a manifest duty with reckless disregard of the consequences refers to) gives “minority rule” as the correct answer.  I believe that this should be “business judgment rule.”

/Rick

I work for a US healthcare organization at a hospital in a country where the culture differs remarkably from that of the US.  An ethical question came up at no fewer than three meetings of differing committees at this HCO, and I'd like to get others' thoughts on the subject.  The question focuses on whether or not to perform urine pregnancy tests (UPT) on all women of childbearing age who arrive at the emergency department (ED) for any reason.  Those in favor argue that it is good medicine.  Those opposed point out that there are serious cultural and traditional reasons not to impose this policy across the board. 

In this country, it is a legal offense to have sexual relations outside of marriage.  If an unmarried woman is found to be pregnant, severe repercussions may occur.  If she is not a citizen, she may be deported.  If she is a citizen, her life is essentially ruined as there will be no chance for marriage (traditionally arranged by families).  In either case, upon giving birth, she could be sent to jail.

At issue here is not whether we agree with aspects of the culture.  The best we can say is that it differs from our own.  How then do we work within this context to provide the highest quality health care?

While the false-positive rate for the UPT is low, it is not zero.  Culturally sensitive individuals at meetings I have attended suggest at least getting informed consent before performing a UPT on an unmarried woman.  Others believe this should be routine, like checking the blood pressure or taking a temperature.  I think this is a serious ethical dilemma and would like to hear how others might weigh in if faced with this question.

An ethical question:

What should be done if a patient has a living will and states in front of physicians and staff their wishes?  They have named a specific family member as the surrogate.   The patient's wishes are not upheld after thier status deteriorates and the family goes against the living will.   During this time the staff know the patien's wishes prior to their status deterioriating  and is having problems with the entire process.        

I've read through the packet for the Finance section of the exam and the Well-Managed Healthcare Organization. I don't see any mention of fund accounting. The academic medical center uses "fund accounting".  Anyone know what this means in the context of the financial accounting we're studying here?

Thanks,