The doctor’s dilemma: is it ever good to do harm?

The Guardian, 9 February 2017
Author: Gwen Adhsead
“Medical knowledge changes swiftly, and technological changes make new and expensive investigations and treatments possible that were only theoretical a few years ago. Life has been extended in length, but not in quality, and the debates about end?of?life decisions show us how much the notion of a “good life” is bound up with the absence of disease, illness and suffering.”
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Clinical ethics issues in HIV care in Canada: an institutional ethnographic study

BMC Medical Ethics 2017 18:9
Authors: Chris Kaposy, Nicole R. Greenspan, Zack Marshall, Jill Allison, Shelley Marshall, Cynthia Kitson
“We found that health care providers and clinic clients have developed work processes for managing ethical issues of various types: conflicts between client-autonomy and public health priorities (“treatment as prevention”), difficulties associated with the criminalization of nondisclosure of HIV positive status, challenges with non-adherence to HIV treatment, the protection of confidentiality, barriers to treatment access, and negative social determinants of health and well-being.”
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Ethical framework for the detection, management and communication of incidental findings in imaging studies, building on an interview study of researchers’ practices and perspectives

BMC Medical Ethics 2017 18:10
Authors: Eline M. Bunnik, Lisa van Bodegom, Wim Pinxten, Inez D. de Beaufort, Meike W. Vernooij
“As thousands of healthy research participants are being included in small and large imaging studies, it is essential that dilemmas raised by the detection of incidental findings are adequately handled. Current ethical guidance indicates that pathways for dealing with incidental findings should be in place, but does not specify what such pathways should look like.”
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The Ethics of Interventional Procedures for Patients Too Ill for Surgery

JAMA. 2017; 317(4): 359-360
Authors: Michael Nurok, Raj Makkar, Bruce Gewertz
“Nonoperative interventional procedures are increasingly viable options for patients considered too ill for surgery. The long-term benefits of catheter-based interventions such as aortic valve replacements or stents for aortic aneurysms and dissections are favorable and continue to be elucidated. In particular, the substantially reduced morbidity attributable to catheter-based interventions makes these procedures compelling options for high-risk patients who may not survive open operations.”
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Studies find worrying over- and underuse of medicine worldwide

Reuters, 8 January 2017
Author: Kate Kelland
“Up to 70 percent of hysterectomies in the United States, a quarter of knee replacements in Spain and more than half the antibiotics prescribed in China are inappropriate, overused healthcare, researchers said on Monday.”
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Views on mandatory reporting of impaired health practitioners by their treating practitioners: a qualitative study from Australia

BMJ Open 2016; 6:e011988
Authors: Marie M Bismark, Ben Mathews, Jennifer M Morris, Laura A Thomas, David M Studdert
“Since 2010, health practitioners in Australia have had a legal obligation to notify the Australian Health Practitioner Regulation Agency (AHPRA) if they have a reasonable belief that another health practitioner has practiced while intoxicated, engaged in sexual misconduct, significantly departed from professional standards or placed the public at risk of substantial harm because of an impairment. The purpose of the legislation is to protect the public, by ensuring that practitioners practice in a competent and ethical manner. Controversially, the mandatory reporting duty extends to practitioners who provide clinical care to an impaired practitioner, such as a psychiatrist who treats an anaesthetist with a substance use disorder or a neurologist who cares for a general practitioner with dementia. Such ‘treating practitioners’ and ‘practitioner-patients’ form the focus of this study.”
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Navigating Ethical Tensions in High-Value Care Education

JAMA. 2016; 316(21): 2189-2190.
Authors: Matthew DeCamp, Kevin R. Riggs
“Enthusiasm for high-value care is increasing throughout health care, including in the education of medical students, residents, and fellows. Until recently, there were few examples of educational programs that equipped future physicians with the tools required to practice high-value care or even consider the cost of care they deliver. In fact, future physicians were encouraged to provide care that could be considered as quite the opposite—academia often instilled excess over restraint, celebrating trainees who generated (and tested for) the broadest differential diagnosis. Because physicians who train in high-spending regions subsequently provide more costly care than those who train in low-spending ones, medical school and residency are critical times to teach high-value care.”
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