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  • 1. The Ethical Pathologist
  • 2. Odontologicalethics
    Duty in good faith is ethical (independent
    of outcome)
    Consequence-based ethics
    Acting to increase health benefit is ethical
    Classical clinical ethics (4-principles)
    Autonomy & beneficence
    justice
    Ethics in medicine (briefly)
  • 3. Clinical ethics applied to pathology
    4-principles apply but are clumsy
    Designed for face-to-face patient care
    Ethics in pathology
    Autopsy and tissue retention
    Surgical pathology: not much written!
    Ethics in pathology
  • 4. 'Now this quack wants me to see a specialist- what the hell is a PATHOLOGIST!?
  • 5. Leave clinical ethics aside
    Concentrate on ethics for pathologists
    See how this can help us be ethical pathologists
    Our approach in this Lecture
  • 6. Pathologists are Guardians of the Wax
  • 7. Legal issues and the pathologist
    Civil liability
    Licensure & disciplinary actions
    Torts and discipline
    Misdiagnosis of biopsies and cytology
    Breast, prostate, lung, pap smears
    Misdiagnosis of forensic autopsies
    Murder, child abuse
    Ethical issues are often legal
  • 8. How can we be ethical pathologists?
  • 9. To whom we owe a duty Trust relationships:
    Patients
    Other physicians
    Pathologists, surgeons, oncologists
    Technologists
    Histology and cytology
    Medical community
    Public
    Courts and Coroner
  • 10. Surgical pathology and cytopathology
    Medical autopsy
    Forensic autopsy
    Second opinion reviews***
    Oncology: Cancer treatment
    Forensic: Expert witness
    Today we will concentrate on surgical
    pathology
    The scope of our work: ethicseverywhere
  • 11. Ethical issues most frequent with
    misdiagnosis
    Misinterpretation (under & over-call)
    Disclosure of errors
    Shared decision-making for patients
    Pathologist = tissue diagnosis
    Clinicians = clinical diagnosis
    Who is responsible for an inappropriate
    treatment decision?
    The ethical surgical pathologist
  • 12. Over-call misinterpretation
    Un-necessary operation (organ removal)
    Chemo and radiation therapy
    Premature death by therapeutic
    complications
    Under-call misinterpretation
    Delayed diagnosis (increased stage)
    Delayed therapy
    Premature death by disease
    Pathologic misdiagnosis
  • 13. Clinical & radiologic
    Mobile nodule (3 cm)
    Not cystic or microcalcified
    Needle core biopsy
    High-grade invasive ductal carcinoma
    No excisionalbiopsy
    Radical mastectomy
    No quick section or sentinel node biopsy
    50 year old woman with abreast lump
  • 14. Primary breast lymphoma
    Un-necessary radical operation
    Treatment would have been different
    Post-operative complications
    Wound infection
    Lymphedema of arm
    Increased risk of other complications
    Radical mastectomy
  • 15. Pathologist-patient relationship
    Punch's view of one patient's reaction to the new methods of diagnosis
  • 16. PATIENT
    Right diagnosis
    Blind trust
    Definitive
    Since therapy is based on it
    Anonymous
    Faceless pathologist
    “The Lab”
  • 17. PATHOLOGIST
    Tissue diagnosis
    Gold standard
    Objective
    Scientific and
    minimally subjective
    Anonymous
    Faceless patient
    Patient is a number
  • 18. A slide is part of a patient Not only an
    exercise in pattern recognition
    We often dissociate reading slides with a
    pivotal medical act
    Pressures of work often make us
    concentrate on signing out rather
    than our role as medical consultants
    The ethics of diagnosis: 1
  • 19. How we act in an ethical dilemma
    speaks about us as physicians and people
    Pride (arguing about being right when you
    are wrong)
    Shame of making a mistake
    Questioning your worth as a person and a
    physician
    People may judge you on how you react
    The ethics of diagnosis: 2
  • 20. Never cover-up a mistake
    No one wants to make mistakes but we
    all do
    Rarely (2% in surgical pathology)
    Most errors do not cause patient harm
    Some errors lead to serious harm, loss of
    liberty, or death
    Make a commitment to life-long learning
    The ethics of diagnosis: 3
  • 21. Good ethics comes as much from the search to be ethical as it does from understanding ‘ethics
    How to be an ethical pathologist