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10 - Commitment to Professional Responsibilities

Published online by Cambridge University Press:  25 February 2010

Jack Coulehan
Affiliation:
Head, Division of Medicine in Society, Department of Preventive Medicine Institute for Medicine in Contemporary Society, SUNY at Stony Brook
John Spandorfer
Affiliation:
Jefferson Medical College, Philadelphia
Charles A. Pohl
Affiliation:
Jefferson Medical College, Philadelphia
Susan L. Rattner
Affiliation:
Jefferson Medical College, Philadelphia
Thomas J. Nasca
Affiliation:
Jefferson Medical College, Philadelphia
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Summary

COMMITMENT TO PROFESSIONAL RESPONSIBILITIES – ADULT PRIMARY CARE

A family physician has seen an unmarried female patient for many years. She is now fifty years old. He has been managing her preventive medical care as well as osteoarthritis and “white-coat hypertension.” Following his divorce, he encounters this patient at a social event and they become romantically involved.

A Perspective from a Primary Care Physician

Clinical Background

“White coat hypertension” is a common clinical finding in which patients are found to have high blood pressure readings in the medical office, but normal readings when home or at rest. Blood pressure normally varies with different activities and times of day. However, some people have hypertensive readings while in stressful or anxiety-producing situations, but normal pressure at other times. White coat hypertension is an example of this phenomenon. Continuous ambulatory blood pressure testing permits determination of mean systolic and diastolic pressures over twenty-four hours. Many authorities believe patients with mean pressures of 135/85 or above should be treated. However, the value of treating white coat hypertension with medication remains controversial.

Professionalism Considerations

The ancient oath of Hippocrates includes several specific injunctions that contemporary oath-takers might find archaic or controversial. Among these are pledges to avoid performing surgery, abortion, and euthanasia.

Type
Chapter
Information
Professionalism in Medicine
A Case-Based Guide for Medical Students
, pp. 397 - 452
Publisher: Cambridge University Press
Print publication year: 2009

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