Ethics

Breaking Bad News to Patients- A Challenge for Residents

March 13, 2008
Breaking Bad News to Patients- A Challenge for Residents

Commentary by Parul Gandhi MD, PGY-2

Bad news can be defined as “Situations where there is either a feeling of no hope, a threat to a person’s mental or physical well-being, a risk of upsetting an established lifestyle, or where a message is given which conveys to an individual fewer choices in his or her life.”(1)

As residents, we spend our time caring for patients and their families. Despite all of our valiant efforts, though, there are times when we must deliver…

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Ethical Dilemmas: Medical Futility-The Texas Approach

March 6, 2008
Ethical Dilemmas: Medical Futility-The Texas Approach

Commentary by Vlad Fridman MD, PGY-3

Futility is a topic which has been debated since the beginning of modern medicine. In Hippocratic times, medical practitioners were called upon to serve three purposes: cure, comfort, and refuse to treat those who were overmastered by illness. (1) The distinction was much clearer when things like CPR, ventilators, and dialysis machines were not yet available. These and other life-sustaining/saving medical techniques have blurred the line of when a person is “overmastered by illness” making it…

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Grand Rounds: “When Things go Wrong”

December 26, 2007
Grand Rounds: “When Things go Wrong”

Commentary by Rosemary Adamson MD, PGY-2

Medical error, the most formidable of topics, was under discussion at ground rounds this past week. Dr. Tom Delbanco visited us from Boston to show his movie about patients’ and their families’ experiences of medical errors. Dr. Delbanco graduated from Columbia Medical School and did his residency at the Columbia Medical Division at Bellevue Hospital. He then moved to Harvard where he created one of the first primary care practice and teaching programs at an academic medical center; he…

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Grand Rounds: “Communicating the Benefits and Harms of Prescriptions Drugs”

December 19, 2007
Grand Rounds: “Communicating the Benefits and Harms of Prescriptions Drugs”

Commentary by Puja Korabathina PGY-3

This week’s medicine Grand Rounds was presented by Drs. Steven Woloshin and Lisa Schwartz , both alumni of NYU’s residency program who are currently performing research and practicing medicine at the Department of Medicine at Dartmouth Medical School. During their years of residency at Bellevue, they became interested in understanding the elements of and barriers to patient-doctor communication. Their current area of research — communicating the risks of prescription drug benefits in an accurate and thoughtful manner — is an extension…

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Ethical Dilemmas: Artificial Feeding

December 7, 2007
Ethical Dilemmas: Artificial Feeding

Commentary by Shrujal Baxi MD, Ethics Section Editor, and Joseph Lowy MD, Medical Director, Palliative Care Service at NYU Hospital

Mrs. Pleasant is an 85 year old woman brought into the ER by her son for poor appetite. Mrs. P is demented secondary to progressive Alzheimer’s disease and has had 3 hospitalizations in the last year for pneumonia, possibly related to aspiration.  Upon physical exam, she is oriented to herself, but is unable to provide any other information. She denies pain and appears to be…

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An Update on Domestic Violence

September 6, 2007
An Update on Domestic Violence

Commentary by Sean Cavanaugh MD, Associate Editor, Clinical Correlations

Most doctors are aware that Domestic Violence, or Intimate Partner Violence (IPV), is a serious health care issue, but the statistics are still startling to most of us. Some surveys have reported that IPV affects up to 30% of women and up to 7.5% of men. These numbers are highly variable and depend on the type of survey being conducted and the population being surveyed. Actual report-statistics of IPV are widely acknowledged as…

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Ethics 101-How Do You Approach a Jehovah’s Witness Patient Who Needs a Transfusion?

February 5, 2007
Ethics 101-How Do You Approach a Jehovah’s Witness Patient Who Needs a Transfusion?

A 76 year old man with a history of coronary artery disease, diabetes and hypertension was brought in by his wife with two days of lethargy, slurred speech and right arm weakness. On presentation, the patient was awake and intermittently involved in conversation.  He was afebrile, with a pulse of 90 and blood pressure of 166/98  His exam was remarkable for dysarthria, orientation only to person, pinpoint pupils, left sided tongue deviation, 3/5 motor strength in the right upper extremity, 4/5 motor strength in…

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A Debate: Should Smokers be Denied Surgery?

January 12, 2007
A Debate: Should Smokers be Denied Surgery?

In last week’s issue of the British Medical Journal, two physicians argue about the merits of refusing to perform elective surgeries on smokers. The debate has been spurred by a primary care group in the UK who announced last year that it would take smokers off waiting lists for surgery in an attempt to contain costs. The proponent, Matthew Peters, argues that, for elective procedures such as plastic, reconstructive, and orthopedic surgeries, the rates of complications in smokers are so high that the increased costs…

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