Challenges to our professional   attitudes –   ethical implications of uncertainty in GP/FM The uncertain doctor Professor...
Aims of the presentation <ul><li>&quot;wait and see“ </li></ul><ul><li>&quot;let's try this“ </li></ul><ul><li>&quot;best ...
Definition of Uncertainty   <ul><li>&quot;The core predicament of medicine -- the thing that makes being a patient so wren...
The Uncertain Doctor <ul><li>There are some things that you know to be true, and others that you know to be false; yet, de...
The Uncertain Doctor <ul><li>Medical history  (do we get all the  f acts) </li></ul><ul><li>Current status  (can we check ...
Definition of Intervention   <ul><li>The act of intervening, interfering or interceding with the intent of modifying the o...
Wait and See <ul><li>Prostate cancer, ARI… </li></ul><ul><li>Is this also an “intervention”? </li></ul><ul><li>Watchful wa...
Doctors Who Can not Cope <ul><li>&quot;let's try this“ </li></ul><ul><li>&quot;best be safe“ </li></ul><ul><li>&quot;medic...
Hurdles and Opportunities <ul><li>research, guidelines </li></ul><ul><li>individual health </li></ul><ul><li>patient auton...
Concluding Remarks <ul><li>Uncertainty is certain </li></ul><ul><li>The level of management of uncertainty war y s between...
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Challenges To Our Professional Attitudes Jk09

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Challenges To Our Professional Attitudes Jk09

  1. 1. Challenges to our professional attitudes – ethical implications of uncertainty in GP/FM The uncertain doctor Professor Janko Kersnik , PhD, MSc, MD Family Medicine Department Medical School Ljubljana and Maribor Slovenia
  2. 2. Aims of the presentation <ul><li>&quot;wait and see“ </li></ul><ul><li>&quot;let's try this“ </li></ul><ul><li>&quot;best be safe“ </li></ul><ul><li>&quot;medico-legally….“ </li></ul><ul><li>high referral rates </li></ul><ul><li>overuse of medical services </li></ul><ul><li>unnecessary prescribing </li></ul><ul><li>public health vs. individual health </li></ul><ul><li>uncertain science </li></ul><ul><li>Whose interests? </li></ul><ul><li>Whose autonomy? </li></ul><ul><li>Honesty </li></ul>
  3. 3. Definition of Uncertainty <ul><li>&quot;The core predicament of medicine -- the thing that makes being a patient so wrenching, being a doctor so difficult and being a part of a society that pays the bills they run up so vexing -- is uncertainty,&quot; observed the surgeon Atul Gawande. &quot;Medicine's ground state is uncertainty. And wisdom -- for both patients and doctors -- is defined by how one copes with it.&quot; </li></ul><ul><li>Source: Complications: A Surgeon's Notes on an Imperfect Science. By Atul Gawande. Metropolitan Books/Henry Holt & Co., New York, 2002. </li></ul>
  4. 4. The Uncertain Doctor <ul><li>There are some things that you know to be true, and others that you know to be false; yet, despite this extensive knowledge that you have, there remain many things whose truth or falsity is not known to you. We say that you are uncertain about them. You are uncertain, to varying degrees, about everything in the future; much of the past is hidden from you; and there is a lot of the present about which you do not have full information. Uncertainty is everywhere and you cannot escape from it. </li></ul><ul><li>Dennis Lindley , Understanding Uncertainty (2006) </li></ul>
  5. 5. The Uncertain Doctor <ul><li>Medical history (do we get all the f acts) </li></ul><ul><li>Current status (can we check all necessary items, can we be sure about our diagnoses) </li></ul><ul><li>Outcomes: </li></ul><ul><ul><li>Natural course (can we be sure that in the observed period there is not any possibility of an undesired outcome) </li></ul></ul><ul><ul><li>Interventions (can we be sure in the absolute success of our activities) </li></ul></ul><ul><li>Doctor patient relationship (can we explain everything that might happen, can we trust in a patient’s capability to decide and intervene appropriately) </li></ul>
  6. 6. Definition of Intervention <ul><li>The act of intervening, interfering or interceding with the intent of modifying the outcome. </li></ul><ul><li>In medicine, an intervention is usually undertaken to help treat or cure a condition. </li></ul><ul><li>From the Latin intervenire, to come between. </li></ul>
  7. 7. Wait and See <ul><li>Prostate cancer, ARI… </li></ul><ul><li>Is this also an “intervention”? </li></ul><ul><li>Watchful waiting (thorough systematic observation on the basis of anticipated possible outcomes with a plan to intervene in specific conditions which might arise from the present status) </li></ul><ul><li>In prostate cancer PSA, DRE, etc. </li></ul>
  8. 8. Doctors Who Can not Cope <ul><li>&quot;let's try this“ </li></ul><ul><li>&quot;best be safe“ </li></ul><ul><li>&quot;medico-legally….“ </li></ul><ul><li>unnecessary prescribing </li></ul><ul><li>overuse of medical services </li></ul><ul><li>high referral rates </li></ul>
  9. 9. Hurdles and Opportunities <ul><li>research, guidelines </li></ul><ul><li>individual health </li></ul><ul><li>patient autonomy </li></ul><ul><li>patient rights </li></ul><ul><li>doctor’s autonomy </li></ul><ul><li>science </li></ul><ul><li>guidelines </li></ul><ul><li>new scientific facts </li></ul><ul><li>uncertain science </li></ul><ul><li>public health </li></ul><ul><li>science, guidelines </li></ul><ul><li>insurance plans </li></ul><ul><li>legal frame </li></ul><ul><li>patient’s demands </li></ul><ul><li>consumerism </li></ul><ul><li>not learning </li></ul>vs. vs. vs. vs. vs. vs. vs. vs.
  10. 10. Concluding Remarks <ul><li>Uncertainty is certain </li></ul><ul><li>The level of management of uncertainty war y s between doctors and within an individual doctor from case to case and in time </li></ul><ul><li>Doctors and patients have to be aware of it and must learn to live with it </li></ul><ul><li>Doctors have to explain the level of uncertainty to the patients and document it </li></ul><ul><li>Management of uncertainty should be taught, studied and trained in medical curricula </li></ul>

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