Markenzie Jean-baptiste

Bio Ethics

12/9/2018

 

In this paper, I will draft an ethical framework guide that I intend to use during my first five years of clinical practice as a licensed certified physician assistant.

I realized I wanted to pursue a career as a physician assistant while working as a medical scribe and manager at an urgent care practice in New York City. Working along side physician assistants allowed me to learn a lot about medicine and patient care from them. I was able to appreciate how valuable physician assistants are to healthcare in that they are able to evaluate, diagnose and treat patients similar to how doctors can. The greatest aspect about being a physician assistant is the flexibility in being able to work in different specialties. I realized that becoming a physician assistant would enable me to care for many patients through all walks of life, as well as learn about and treat a variety of medical problems by working in different specialties.

 

The aspects of clinical practice that I anticipate will be of most importance to me as a practicing physician assistant are conducting a patient centered interview, obtaining informed consent and protecting patient’s health information. Conducting patient centered interviews will enable me to understand more of the patient’s perspective regarding their medical illness and use it in conjunction with objective clinical findings when formulating differential diagnoses and creating treatment plans (Haidet, 1135). Obtaining informed consent is important because it will allow me to educate my patients about their health, risks and benefits about a proposed procedure ensuring that they fully understand before agreeing with a treatment plan (Ripley, 1639). Protecting patient’s heath information is important because it will promote patients to have more trust and confidence when disclosing their health information and medical problems with me (Kirk, 280). All three of these aspects of clinical practice I believe promote good quality healthcare and optimal health outcomes for patients.

 

The three ethical principles that I anticipate will play the strongest role in my ethical decision making while practicing are beneficence, autonomy and confidentiality. Beneficence means practicing medicine with the intention of promoting the patient’s welfare, preventing disease and injury, as well as removing harm from patients (Yeo, 103). Autonomy as effective deliberation for a patient involves having the ability to understand and rationalize thoughts regarding a decision about a proposed care plan or treatment ( Yeo, 94).  While making ethical decisions regarding a patient’s care, I will aim to respect the patient’s autonomy by adequately educating them about their healthcare options and promoting shared decision making regarding their care (Ripley, 1639). Confidentiality means to practice medicine in a way that strengthens the trust and confidence between patients and their medical provider( Kirk, 280). Respecting the confidentiality of a patient includes protecting the medical information they disclose during a consultation.

 

Beneficence, autonomy and confidentiality are the best principles to support the three aspects of clinical practice I have proposed. Patient centered interviewing is an act of beneficence because the more a physician learns about a patients perspective regarding their health, the better they are at tailoring a treatment plan that the patient is more likely to follow (Haidet, 1135).  This is because the physician will be able to consider the psychosocial factors as well as the biomedical issues affecting the patient’s health. In a hypothetical example, a physician may learn during a patient centered interview that a patient is worried about the financial costs of a proposed medication. The costs could discourage the patient from filling the prescription which can worsen the patients symptoms affecting healing. In an act of beneficence, the physician can switch the prescription to a much more affordable medication that the patient can fill. In a physician-centered interview that focuses on just the biomedical factors, this information may not be discovered and the patient may not fill the prescription. In this case, prescribing the medication would not be an act of beneficence.

Autonomy as effective deliberation, as well as beneficence can explain the informed consent process.  In the informed consent process, shared decision making occurs in which the provider explains the care options including risks and benefits with the patient, and the patient asks questions and communicates preferences to the provider (Ripley 1639). The provider then confirms that the patient understands all aspects of the procedure. By following the informed consent process, the patient is able to exercise autonomy by being able to effectively deliberate the care options and make a decision regarding his or her care.  The informed consent process is also an act of beneficence because studies have shown that failure of physicians confirming that the patient understands the details regarding a procedure during the informed consent procedures increases risk of medical errors (Ripley 1639).

 

Confidentiality, autonomy and beneficence can explain protecting patients health information. When patients share their personal information with a provider during a health consultation, the provider should use the patient’s information in a way agreed upon by the patient (Kirk 280). Most of the time, this information is sensitive and the patient would not want anyone else other than the provider to know. Protecting the patients health information by using it in a way agreed upon by the patient is an act of respecting the patients confidentiality( Kirk, 280). Protecting patient’s health information is also an act of beneficence because it leads to better clinical outcomes for the patient. This is because patients will be more likely to disclose private information about their life that may be pertinent to the reasons for their medical problems. As a result, the provider is more likely to make a successful diagnosis and the patient is more likely to follow the treatment plan of the provider due to the trust that is built (Kirk,280).

 

In conclusion, I believe that the ethical framework I have outlined in this paper will serve as a great guide for my first five years of clinical practice as a licensed certified physician assistant.

 

 

Sources:

 

1) Haidet, P. & Paternitti, DA. (2003). “Building” a history rather than “taking” one.   Archives of Internal Medicine 163, 1134-1140.

 

(2)Ripley, A. et al. (2015). Improving the informed consent conversation: A standardized checklist that Is patient centered, quality driven, and legally sound . Journal of Vascular & Interventional Radiology, 26(11),1639-46

 

(3) Kirk, TW. (2015).  Confidentiality .  In N Cherny, M Fallon, S Kaasa, R Portenoy, & D Currow (eds.). Oxford Textbook of Palliative Medicine. (5^th ed.) New York/London: Oxford University Press, pp. 279-284.

 

(4) Yeo, Michael et al. (2010). Beneficence . In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 103-116

 

(5) Yeo, M et al. (2010). Autonomy [selections]. In M Yeo et al. (eds.). Concepts and Cases in Nursing [3rd edition] Ontario: Broadview Press, pp. 91-97, 103-109.