Archive for July, 2011

Bioethics in medical education

[I wrote this for my medical blog as a practice of saying something coherent about the idea of virtue ethics in medical training. This is one of the reasons I got interested in doing the theology masters. It should be fairly readable to non-medics. Let me know what you think]

Ethics is tricksy.

No way round it.

There are lots of reasons for that, the type of thing that keeps philosophy and ethics departments in good work.

Approaches to ethics in med school are always going to be hopelessly inadequate, it’s perhaps unfair to expect much else.

This paper discusses ethics and how to train people in ethics in EM. And they say lots of good things. It’s just that it’s a tad reductionist for my liking.

Ethics curriculum for emergency medicine graduate medical education. J Emerg Med. 2011 May;40(5):550-6. Epub 2010 Oct 2. PMID 20888722

Fig 1 from the paper

That figure may make a lot of sense to you. It certainly makes sense to me I’m just not sure it’s an entirely appropriate way to teach ethics or indeed practice it.

Or maybe it is. It’s probably a perfectly decent way to teach ethics if you believe that ethics is just another abstracted category to be put alongside physiology and anatomy.

The authors make this quote

a sound understanding of the principles of bioethics is necessary to become a compassionate and effective physician

Here I disagree. I do not know how an understanding of bioethics makes a doctor more or less compassionate.

Compassion in the context of virtue, character and humanity may be a learnable skill through the practice of a life lived but I’m not sure it’s teachable in the sense you can pass an MCQ at the end of it.

They do mention one thing that might be good material for fruitful reflection

Ethics education can be effectively provided, not only through behaviour modelling in the clinical environment, but also in formal didactic instruction

While I think the didactic instruction has its limitations as discussed above I think the “behaviour modelling” is fascinating.

Which brings me to this paper:

A Window on Professionalism in the Emergency Department Through Medical Student Narratives. Ann Emerg Med. 2011 May 28. [Epub ahead of print] PMID 21624702

Medicine is a lot like apprenticeship. In the sense that personalities and relationships are a key part of our learning and skill development. I model the behaviour and knowledge and skills that I find in my seniors.

These guys called the modelled professionalism by seniors “the hidden curriculum” which is kind of a neat name. Basically the students take on the habits of the senors and the practices observed.

I am deeply grateful to the people I have worked with both for the things that they have taught me to do and the things that I have seen them do and vowed never to repeat!

The term “holistic” is in vogue when it comes to talking about patients. It’s unfortunate that it’s become a buzzword as it’s actually a useful reminder that we treat people, not just patients, and certainly not conditions.

To think of ethics training and the practice of medicine as easily definable and teachable components that can be formed in an algorithm is something I find quite inadequate.

Some (tongue in cheek) conflicts of interest:

  • I think medical training is there to produce people capable of caring for the suffering, sick and the dying. These people need to both retain their own humanity and help their patients retain theirs. (This need not be in conflict with the good science and practices that fill medical research journals)
  • As background to this I am not a materialistic determinist. I have problems with a lot of the assumptions modernity has given us. I am a confessing Christian and a big fan of virute ethics. Though I’ll gladly admit Aristotle was a bit bonkers on a whole range of things…
  • I’m starting a masters in theology in the hope of exploring this kind of thing a bit further. And hopefully make it in some way intelligible and not just vague allusions to Macintyre

Harvest is here… well not quite…

Off on hols to kerry for a bit. Decided to pull a few veg to bring with us for food

However when I add a scale they’re not quite as impressive

There’s some tasty eating in a carrot the size of a euro…

Clues as to why my brownies kick your brownies ass

Though it makes me suspect they’re not suitable for small children or if you have to operate heavy machinery…







On the few occasions that I stop long enough to consider even hearing the still small voice of God, I think of kindness.

In the sense of kindness, gentleness, self-control  that is. Fruits of the spirit and all that.

I once quoted Vonnegut from one of his novels where the character Eliot Rosewater is baptising/christening and gives his one rule for living on planet earth

God damn it you’ve gotta be kind…

I find myself deeply moved by kindness. Kindness observed amongst those I know and don’t know. The kindness of the people I work with in how they deal with people. And I lament my failings in dealing with those I love; how quick I am to anger or criticism or jibes – more in the name of humour and superiority than grace.

I get angry at the lack of kindness, most often exhibited on occasions where I work in the hospital. The “God damn it..” in exasperation and anger seems fitting.

Hippocrates shadow

I’ve just finished reading this (in a rather frenzied 8 hour marathon) fascinating book by David Newman, a damn fine educator and researcher in emergency medicine

It covers all the problems with medicine that i’ve been torturing my poor friends over for donkeys now.

There’s lots of great stuff in it but I think my personal favourite is chapter 4 on communication with patients.

Lack of communication begets lack of communication. a downward spiral closely ties to medicine’s movement away from contact toward technology, a movement embraced by patients and doctors alike. Both groups crave the safety and the seemingly unimpeachable science represented by blood tests, x-rays, and pills

If you’re fed up with me ranting to you about the problems inherent in the medical world then read this. It’s much better articulated than I’ll ever manage to be.

It’s written for a lay audience so it’s fairly accessible to everyone

More from yer man

For Christians do not put their hope in their children, but their children are a sign of a hope, in spite of considerable evidence to the contrary, that God has not abandoned this world.

Stanley Hauerwas

Community of Character

P 191


July 2011