Facing Ethical Dilemmas: A Challenge for Residents

Marty Krawczyk

At the Practice Management Symposium for Orthopaedic Residents held on Tuesday, Charles Carroll IV, MD, chair of the AAOS Ethics Committee, took residents through a series of possible ethical dilemmas faced by orthopaedists early in their career.

According to Dr. Carroll, ethics is an established system of moral principles that govern the rules of conduct. Medical ethics define what the physician ought to do and how he or she should behave. “Medical ethics is similar to orthopaedic surgery in that there may not be one ‘correct’ answer for every situation. Further, because of various state laws, what is acceptable in one location may not be appropriate in another location. An orthopaedic surgeon has an obligation to know and to follow the law in his or her community,” he said.

In dealing with an ethical situation, advised presenter Kenneth C. Thomas, MD, an orthopaedic trauma surgeon in Anchorage, Alaska, it pays to think ahead. “Mistakes will happen in your orthopaedic career!” said Dr. Thomas. “It is important for you as residents to begin now to plan how you will handle the situation when a mistake happens. By doing so, you establish a pattern of behavior you will follow in the first 5 years of practice and beyond.”

Dr. Thomas recommended that physicians avoid the self-deception trap at all costs. Rather than using the “ostrich” technique, it is best to identify errors as early as possible, acknowledge them, and take the necessary steps to make things right. “Be your own worst critic,” he said.

Learning how to manage ethical dilemmas is a life skill, not something that can be gotten by reading a book, so Dr. Thomas recommended that residents follow these simple guidelines:

a. Ask yourself, “What’s the right thing to do?”

b. Tell the truth.

c. Ask for help—you are not alone.

d. Be nice!

The third presenter, Mark A., Yaffee, MD, a postgraduate fifth-year resident at the Northwestern University Department of Orthopaedic Surgery, discussed the “top five” potential ethical dilemmas facing residents as they complete their residency and fellowship programs.

Attendees also heard from Steve M. Harris, JD, on how to negotiate physician employment agreements; Michael J. Rogal, MD, JD, on aspects of medical malpractice, including tips for serving as a witness and helping your attorney; and Ryan M. Dopirak, MD, on the advantages and disadvantages of the various practice settings.

Get some practice
The AAOS Resident Ethics Series is available to residents in training and others on the AAOS OrthoPortal website (www.orthoportal.org). It is designed to present a set of issues in a case presentation format. Dr. Carroll noted that discussing ethical issues in orthopaedic surgery is essential because how they are managed can greatly affect a physician’s livelihood.

The AAOS also has many other resources available to residents as they prepare to enter practice. Residents are encouraged to take full advantage of the resources available via the AAOS website.

For more information on practice management resources, visit the Practice Management kiosk in Academy Hall B, or explore the online practice management center at www.aaos.org/pracman

Marty Krawczyk is a member of the AAOS practice management group.

2013 Annual Meeting News
Tuesday through Friday, February 19 – 23, 2013.
http://www.aaos.org/news/acadnews/2013/AAOS14_3_21.asp