At our third medical professionalism matters event in Birmingham on Wednesday evening we discussed some really emotive and challenging ethical issues. Doing what we know to be the right thing is a challenge for us all but it became clear to me last night how hard this can be for doctors. Our keynote speaker, Professor Deborah Bowman’s clever analogy summed this up. She said that medical ethics are like Shakespeare’s Hamlet, as both are constantly reinterpreted. However for Hamlet the decision was “to be. Or not to be.” Unfortunately the reality of ethics in the medical profession is not so neatly divided.
Deborah gave a thought provoking keynote which set up the table discussions and panel discussion that followed. She explained how when she was younger the over simplification in Aesop’s fables was what first started her thinking about ethics. She then summarised the different things that can influence your ‘moral enactment’.
We asked delegates to vote on topical questions at all three of the events so far and it is interesting to compare the results. Interestingly just 44% of our delegates in Birmingham last night disagree that doctors are less compassionate than 20 years ago. This compares to 74% in Bristol and 63% in Newcastle.
Also, in Birmingham 44% of delegates were unsure they would be supported by clinical and other leaders if they were to raise a serious concern. This compares to 21% in Bristol and 26% in Newcastle. You can take part in our poll to let us know what you think.
We also asked two questions specifically relating to ethical dilemmas that doctors face:
The first reinforced how, unlike Hamlet’s dilemma as to whether to take his own life, medical ethics can be anything but black and white. Asked how often they were uncertain as to whether they had made the right decision 57% of delegates said occasionally and 29% often. Deborah’s Hamlet analogy anybody?
In the other question 95% of delegates agreed that while confidentiality is important it should not prevent the sharing of information which is in the public’s best interest.
See all of the slides and voting results from the resilient doctor event [PDF].
During the panel discussion there was an interesting debate around the teaching of ethics. Dr Vinnie Nambisan, Consultant in Palliative Medicine at North Middlesex University Hospital NHS Trust, commented that sometimes we need to divorce values and virtues from behaviour. His point being that we should focus on values when teaching.
Some people thought ethics are learnt best on the job while others thought ethical behaviour is ingrained and not something that can be taught. Professor Kate Thomas from the University of Birmingham Medical School said that often the issue is what happens away from the university as ‘Students need to have the resilience to withstand poor role models.’
What do you think? Can medical ethics be taught? Do you think we could improve the way it is taught?
Dr Mark Porter, Chairman of the BMA’s comment during the panel discussion struck a real chord with delegates and with people following the conversation on social media. He said that doctors should: ‘Make the care of your patient your central concern. It’s a lifelong journey to understand what that means.’
Deborah Bowman made a sensible suggestion which also made me think. She was asked about a doctor who witnessed another doctor being bullied but didn’t do anything about it, and the discussion moved on to having the courage to do the right thing. Deborah’s suggestion was to rehearse how you might respond when faced with a difficult ethical issue. As a reflector this seems such an obvious thing to do but is not something I had ever considered.
I am really enjoying this programme of events. Our aim is to get out and talk to doctors, students and others involved in medicine about real issues that matter to them. In all three of our events so far I think we have achieved that and it has been great to hear some so many people’s different perspectives. At last night’s doctor’s dilemma there were some really animated discussions and we have some excellent content that will feed in to the Medical Professionalism Matters report we are working on.
We have started a LinkedIn group where we hope to continue many of the conversations started on Wednesday. Join the group and tell us what you think by searching for medical professionalism on LinkedIn.
Book your place on the next of these free events, the compassionate doctor in Cardiff on November 19.
Join the conversation using #gooddoctors.