Book contents
- Frontmatter
- Contents
- Contributors
- Acknowledgments
- Introduction
- PART ONE DEFINING MEDICAL PROFESSIONALISM
- PART TWO CASES INVOLVING MEDICAL STUDENTS
- PART THREE CASES INVOLVING PHYSICIANS
- 3 Principle of Primacy of Patient Welfare
- 4 Principle of Patient Autonomy
- 5 Principle of Social Justice
- 6 Commitment to Honesty with Patients
- 7 Commitment to Patient Confidentiality
- 8 Commitment to Improving Quality of Care
- 9 Commitment to Maintaining Trust by Managing Conflicts of Interest
- 10 Commitment to Professional Responsibilities
- APPENDIX: Cases by Specialty
- Index
- References
3 - Principle of Primacy of Patient Welfare
Published online by Cambridge University Press: 25 February 2010
Book contents
- Frontmatter
- Contents
- Contributors
- Acknowledgments
- Introduction
- PART ONE DEFINING MEDICAL PROFESSIONALISM
- PART TWO CASES INVOLVING MEDICAL STUDENTS
- PART THREE CASES INVOLVING PHYSICIANS
- 3 Principle of Primacy of Patient Welfare
- 4 Principle of Patient Autonomy
- 5 Principle of Social Justice
- 6 Commitment to Honesty with Patients
- 7 Commitment to Patient Confidentiality
- 8 Commitment to Improving Quality of Care
- 9 Commitment to Maintaining Trust by Managing Conflicts of Interest
- 10 Commitment to Professional Responsibilities
- APPENDIX: Cases by Specialty
- Index
- References
Summary
PATIENT WELFARE – ADULT PRIMARY CARE
A family physician recommends that an eighty-two-year-old woman with a history of coronary disease take the non-steroidal anti-inflammatory (NSAID) drug celecoxib (Celebrex) for osteoarthritis. The physician chooses celecoxib over a non-Cox 2 inhibitor because of his concern about NSAID-induced gastropathy. Celecoxib requires prior authorization and the physician is aware that the insurance company only allows use of this drug when a patient has tried and is intolerant of other NSAIDs. The physician forwards a note to the insurance company indicating this to be the case, despite the fact that the patient has not tried other NSAIDs.
A Perspective from a General Internist
Clinical Background
Each year, the use of NSAIDs, including aspirin, accounts for a significant amount of gastrointestinal complications, mainly gastric ulcers and gastritis. These complications lead to an estimated 7,600 deaths and over 70,000 hospitalizations in the United States. Factors listed in Table 3.1 have been shown to increase the risk of NSAID-induced gastropathy.
The average duration of NSAID use before the onset of GI symptoms is twelve weeks. The longer the duration of NSAID use, the higher the risk of gastropathy.
There is an approximate 1 percent absolute risk reduction for symptomatic ulcer disease when using celecoxib compared to other non-COX-2 inhibiting NSAIDs over a one-month duration.
- Type
- Chapter
- Information
- Professionalism in MedicineA Case-Based Guide for Medical Students, pp. 115 - 153Publisher: Cambridge University PressPrint publication year: 2009
References
. A guideline for the treatment and prevention of NSAID-induced ulcers. members of the ad hoc committee on practice parameters of the American College of Gastroenterology. Am J Gastroenterol. 1998;93(11):2037–2046.CrossRefGoogle ScholarPubMed
, , , , . Risk factors for serious nonsteroidal-induced gastrointestinal complications: Regression analysis of the MUCOSA trial. Fam Med. 1996;28(3):204–210.Google ScholarPubMed
, . Do cyclooxygenase-2 inhibitors provide benefits similar to those of traditional nonsteroidal anti-inflammatory drugs, with less gastrointestinal toxicity?Ann Intern Med. 2000;132(2):134–143.CrossRefGoogle ScholarPubMed
The Kaiser Family Foundation and Health Research and Educational Trust. Health care marketplace project. 2006.
, , , . Medicaid prior-authorization programs and the use of cyclooxygenase-2 inhibitors. N Engl J Med. 2004;351(21):2187–2194.CrossRefGoogle ScholarPubMed
, , , . Differential effect of early or late implementation of prior authorization policies on the use of COX II inhibitors. Med Care. 2006;44(4):378–382.CrossRefGoogle ScholarPubMed
, , , . National health spending in 2004: Recent slowdown led by prescription drug spending. Health Aff (Millwood). 2006;25(1):186–196.CrossRefGoogle ScholarPubMed
, , , , , . Health spending projections for 2004–2014. Health Aff (Millwood). 2005;Suppl Web Exclusives:W5–74-W5–85.CrossRefGoogle ScholarPubMed
, , , , . Prescribing COX-2s for patients new to cyclo-oxygenase inhibition therapy. Am J Manag Care. 2003;9(11):735–742.Google ScholarPubMed
Assessment of Risk Factors for Preterm Birth. ACOG Practice Bulletin #31. Washington, D.C.: American College of Obstetricians and Gynecologists; 2001.
, , , et al. The length of the cervix and the risk of spontaneous premature delivery. National institute of child health and human development maternal fetal medicine unit network. N Engl J Med. 1996;334(9):567–572.CrossRefGoogle ScholarPubMed
, , , , . Cerclage for short cervix on ultrasonography: Meta-analysis of trials using individual patient-level data. Obstet Gynecol. 2005;106(1):181–189.CrossRefGoogle ScholarPubMed
, , , . Bed rest in singleton pregnancies for preventing preterm birth. Cochrane Database Syst Rev. 2004;(1)(1):CD003581.Google ScholarPubMed
, , , . Long-bone fractures in young children: Distinguishing accidental injuries from child abuse. Pediatrics. 1991;88(3):471–476.Google ScholarPubMed
. Child abuse. In: , , , , , eds. Textbook of Pediatric Emergency Medicine. 5th ed. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2005.Google Scholar
. The challenges of recognizing child abuse: Seeing is believing. JAMA. 1999;281(7):657–659.CrossRefGoogle ScholarPubMed
, American Academy of Pediatrics Committee on Child Abuse and Neglect. Evaluation of suspected child physical abuse. Pediatrics. 2007;119(6): 1232–1241.CrossRefGoogle Scholar
, . Clinical response to child abuse. Pediatr Clin North Am. 2006;53(1):27–39, v.CrossRefGoogle ScholarPubMed
. Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training and Privileging. 2nd ed. American Psychiatric Press; 2001.Google Scholar
, , , , . Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: Systematic reviews and economic modelling studies. Health Technol Assess. 2005;9(9):1–156, iii–iv.CrossRefGoogle ScholarPubMed
, , . Electroconvulsive therapy: Attitudes and misconceptions. J ECT. 2005;21(2):84–87.CrossRefGoogle ScholarPubMed
, . Professionals' responsibilities in releasing information to families of adults with mental illness. Psychiatr Serv. 2003;54(12):1622–1628.CrossRefGoogle ScholarPubMed
, , , . Decisional capacity of depressed elderly to consent to electroconvulsive therapy. J Geriatr Psychiatry Neurol. 2004;17(1):42–46.CrossRefGoogle ScholarPubMed
. American Board of Internal Medicine, ACP-ASIM Foundation. American College of Physicians-American Society of Internal Medicine, European Federation of Internal Medicine. Medical professionalism in the new millennium: A physician charter. Ann Intern Med. 2002;136(3):243–246.Google Scholar
, , Ethics and Human Rights Committee, American College of Physicians. Ethics manual: Fifth edition. Ann Intern Med. 2005;142(7):560–582.CrossRefGoogle Scholar
, . The trouble with families: Toward an ethic of accommodation. Ann Intern Med. 1999;130(2):148–152.CrossRefGoogle ScholarPubMed
, . Dealing with conflict in caring for the seriously ill: “It was just out of the question”. JAMA. 2005;293(11):1374–1381.CrossRefGoogle Scholar
, , , et al. Infected physicians and invasive procedures: Safe practice management. Clin Infect Dis. 2005;40(11):1665–1672.CrossRefGoogle ScholarPubMed
, . Nonmaleficence. In: Principles of Biomedical Ethics. 5th ed. New York: Oxford Univ Press; 2001:113–117.Google Scholar
, . Strategies for preventing sharps injuries in the operating room. Surg Clin North Am. 2005;85(6):1299–305, xiii.CrossRefGoogle Scholar
. HIV and AIDS in the workplace. J Occup Environ Med. 2002;44(6): 495–502.CrossRefGoogle ScholarPubMed
, , , , . Making the case for a paradigm shift in trauma surgery. J Am Coll Surg. 2006;202(4):655–667.CrossRefGoogle ScholarPubMed
. A clash of cultures: Reflections of a physician with a disability. Lancet. 1999;354(9180):763–764.CrossRefGoogle ScholarPubMed
. The physically handicapped physician. In: , ed. The Physician: A Professional Under Stress. Norwalk, CT: Appleton-Century-Crofts; 1983:318–326.Google Scholar
, , , et al. Prognosis and outcomes of patients with community-acquired pneumonia: A meta-analysis. JAMA. 1996;275(2):134–141.CrossRefGoogle ScholarPubMed
. Prognosis and decisions in pneumonia. N Engl J Med. 1997;336(4): 288–289.CrossRefGoogle ScholarPubMed
, , , et al. Does hospitalization impact survival after lower respiratory infection in nursing home residents?Med Care. 2004;42(9): 860–870.CrossRefGoogle ScholarPubMed
, , , et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336(4):243–250.CrossRefGoogle ScholarPubMed
, . Getting to yes: Negotiating agreement without giving in. 1981.
, , , et al. Prevalence and determinants of physician bedside rationing: Data from Europe. J Gen Intern Med. 2006;21(11):1138–1143.CrossRefGoogle ScholarPubMed
, . Preferences for disclosure: The case for bedside rationing. Soc Sci Med. 2004;59(9):1891–1897.CrossRefGoogle ScholarPubMed
, , . Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. JAMA. 1997;278(17):1440–1445.CrossRefGoogle ScholarPubMed
, . Testing strategies in the initial management of patients with community-acquired pneumonia. Ann Intern Med. 2003;138(2):109–118.CrossRefGoogle ScholarPubMed
http://www.mdcalc.com. Accessed August 21, 2008.
. http://www.pda.ahrq.gove. Accessed August 21, 2008.
, , , et al. Infectious diseases society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44 Suppl. 2:S27–72.CrossRefGoogle Scholar
. Clinical policy for the management and risk stratification of community-acquired pneumonia in adults in the emergency department. Ann Emerg Med. 2001;38(1):107–113.CrossRefGoogle Scholar
, , , . Hospitalization for community-acquired pneumonia: The pneumonia severity index vs clinical judgment. Chest. 2003;124(1):121–124.CrossRefGoogle ScholarPubMed
, , , , , . Severe sepsis in community-acquired pneumonia: When does it happen, and do systemic inflammatory response syndrome criteria help predict course?Chest. 2006;129(4):968–978.CrossRefGoogle ScholarPubMed
, , , et al. Defining community acquired pneumonia severity on presentation to hospital: An international derivation and validation study. Thorax. 2003;58(5):377–382.CrossRefGoogle ScholarPubMed
, . Medical Ethics: The Moral Responsibilities of Physicians. Englewood Cliffs, NJ: Prentice-Hall, Inc; 1984.Google Scholar
, . Professionalism: A contract between medicine and society. CMAJ. 2000;162(5):668–669.Google ScholarPubMed
. The Social Contract: A Critical Study of Its Development. Oxford, England: The Clarendon Press; 1957.Google Scholar
. Professionalism and medicine's social contract with society. Clin Orthop Relat Res.2006;449:170–176.Google ScholarPubMed
, , . Renewing professionalism: An opportunity for medicine. Acad Med. 1999;74(8):878–884.CrossRefGoogle ScholarPubMed
, , , et al. Voters and health reform in the 2008 presidential election. N Engl J Med. 2008;359(19):2050–2061.CrossRefGoogle ScholarPubMed
. Modern health care for all Americans. N Engl J Med. 2008;359(15): 1537–1541.CrossRefGoogle ScholarPubMed
, , . Beyond the physician charter: Reflections on medical professionalism. Perspect Biol Med. 2006;49(2):263–275.CrossRefGoogle ScholarPubMed
. The medical profession as a moral community. Bull N Y Acad Med. 1990;66(3):221–232.Google ScholarPubMed
. The performance of doctors. I: Professionalism and self regulation in a changing world. BMJ. 1997;314(7093):1540–1542.CrossRefGoogle Scholar
. See one, do one, teach one: Developing professionalism across the generations. Clin Orthop Relat Res. 2006;449:186–192.Google ScholarPubMed
. Pay for performance and medical professionalism. Qual Manag Health Care. 2008;17(1):9–18.CrossRefGoogle ScholarPubMed
. Viewpoint: Today's professionalism: Engaging the mind but not the heart. Acad Med. 2005;80(10):892–898.CrossRefGoogle Scholar
. Medical professionalism and the generation gap. Am J Med. 2005;118(4):439–442.CrossRefGoogle ScholarPubMed
, , . Physicians' interactions with third-party payers: Is deception necessary?Arch Intern Med. 2004;164(17):1841–1844.CrossRefGoogle ScholarPubMed
, . “Not just another business”: Medicine's struggle to preserve professionalism in a commercialized world. Obstet Gynecol. 2002;100(1):168–169.Google Scholar
, ed. The Complete Works of Aristotle: The Revised Oxford Translation. Princeton, NJ: Bollingen; 1984; No. 2.
, Accreditation Council for Graduate Medical Education (ACGME). Viewpoint: Teaching professionalism: Is medical morality a competency?Acad Med. 2005;80(10):885–891.CrossRefGoogle ScholarPubMed