Latest news with #shareddecisionmaking
Medscape
19-06-2025
- Health
- Medscape
Ethics in Medical School: A Q&A With Dr Holland Kaplan
Holland Kaplan, MD, is an assistant professor in the Center for Medical Ethics and Health Policy and the Section of General Internal Medicine at Baylor College of Medicine in Houston. In this Q&A with Medscape Medical News , Kaplan discussed critical gaps in medical ethics education, challenges in teaching ethical reasoning, and how the field has evolved in response to recent developments in healthcare. The interview has been edited for length and clarity. In your experience, what is the most important ethical issue that often gets overlooked in medical school curricula — and why does it matter in practice? Holland Kaplan, MD I think the most important ethical skill that is underemphasized or inadequately taught in medical school is being able to conduct thorough assessments of patients' decision-making capacity. When physicians lack this ability, they are dependent on other physicians to make this assessment and may over- or under-involve patients in their own decision-making. What's one ethical gray area that students are often surprised by in clinical training? How do you guide them through it? A topic that students find consistently challenging is the concept that it is often ethically appropriate and in line with principles of shared decision-making for a physician to make a medical recommendation to a patient. Our culture of clinical practice has become focused on respecting autonomy sometimes to a fault. I have observed medical students and residents presenting patients with complex clinical options for advanced conditions without providing any guidance to the patient on how to choose between these options — the 'menu' approach. While patients sometimes do want and need to make completely independent medical decisions without physician guidance, more often than not it is appropriate for a physician to guide a patient through the decision-making process and make a medical recommendation based on the patient's values and the clinical situation. What role should ethics play in preparing future physicians to address health disparities and systemic injustice? Ethics education plays a central role in enabling future physicians to address health disparities and systemic injustice. A critical concept taught in medical school and in ethics courses is the importance of patient-centered care — care that respects the rights and preferences of patients to the extent possible. Often, one of the first hints that care is unjust or unequal is when individual patients' rights and preferences are not being fully respected. Ethics education provides a framework and language for articulating how these injustices and inequities take place at a systemic level and how they can be addressed. How do you evaluate whether a student has developed good ethical reasoning — not just memorized principles? Assessing whether a student has developed sound ethical reasoning is quite challenging. I find that the best way to assess students' ethical reasoning is through a dialogue in the clinical setting when they are taking care of patients. This can be done by asking questions about rote ethics knowledge, then asking the student to apply that knowledge to their patient's case, and then asking probing questions about contingency scenarios. It can also be helpful to ask students how they would navigate specific aspects of challenging conversations with patients or families, as this often involves demonstrating the ability to elicit values. How has the teaching of medical ethics changed in recent years? The main way we've seen ethics education change is that the pass or fail grading and optional lectures have decreased student accountability to learn the material. While most students still engage meaningfully with the material, it has become more challenging to ensure that every student has achieved a bare minimum degree of competence in ethics during their medical education. Artificial intelligence has also made it more difficult to assess ethical reasoning via assigned essays. If you could add one ethical topic to every med school curriculum that's currently underrepresented, what would it be and why? It would be education on the concept of 'dual loyalties.' Physicians experience dual loyalties when their allegiance is strongly pulled toward something or someone other than their patient. There are settings where this is more likely to occur, such as when physicians practice in prisons or in the military. However, physicians' loyalty in day-to-day practice can be pulled toward institutional policies, length-of-stay metrics, managed care organizations, and so forth. Medical students are not typically taught about this concept or how to navigate it.
BBC News
15-05-2025
- Health
- BBC News
Parents of Bronwen Morgan call for law change to 'save lives'
The parents of a student nurse who took her own life are calling for a change in the law to ensure mental health patients are supported with decisions about their Morgan, 26, who was diagnosed with a personality disorder, died after being found unresponsive at a Cardiff hotel in parents Jayne and Haydn said shared decision making - when healthcare professionals involve a patient's trusted relative or friend in decisions about their treatment and care - should become the Welsh government said care tailored to people's needs was a key aim in its new mental health and suicide strategies. Bronwen, a Cardiff University nursing student, was diagnosed with a borderline personality disorder, or an emotionally unstable personality disorder, in inquest into Bronwen's death heard that on 27 August 2020 she told her father she would be going to a friend's house, but she never phone was traced to a Premier Inn in Pentwyn, Cardiff, where she was found inquest heard in the days leading up to her death, Bronwen had complained to Cardiff and Vale health board about her package of the coroner found her death and the care she was receiving could not be parents said their daughter attempted to take her life around 40 times in two years, adding that it "became the norm" for the family. "When she did take her life, it wasn't a surprise to us because we could see it coming," said Mrs Morgan."And we were trying to tell her care team, but they'd say they couldn't share anything because of patient confidentiality."Mr Morgan said his daughter would attend reviews of her care where she would be asked how she was, and would incorrectly tell healthcare professionals she was "fine"."Which wasn't the case," said Mr Morgan."But if somebody else was there they would be able to be truthful and honest and say that's not true, you were found on a bridge, or you made an attempt on your life this week."The couple said that is why they would like to see shared decision-making become the law."By having another person there, it will help emphasise what the issues are, which the patient might find too difficult to share," said Mr Morgan."It's also another set of ears in the meeting, because the patient might be strongly medicated or find it too difficult to open up in front of a panel."Mrs Morgan said the idea seemed "a bit of a no brainer to me"."I can understand why some people would not want a family member there, but instead take a trusted friend or mental health advocate," she National Institute for Health and Care Excellence (NICE) website states shared decision-making has a range of benefits, including allowing people to discuss and share information, making sure people have a good understanding of the benefits, harms and possible outcomes of different options and empowering them to make decisions about the treatment and care that is right for them at that time. "If they're not following NICE guidelines, then let's force them to follow them and make it law," Mr Morgan. Bronwen's parents said she was also "encouraged" and "guided" by a suicide coroner asked the UK and Welsh governments to make it harder to access such websites, and the site has since been blocked. A Welsh government spokesperson said their thoughts were with Bronwen's family and loved ones."Tailoring care to people's needs is a key aim in our new mental health and wellbeing strategy and suicide prevention and self-harm strategy," they said."The NHS Executive is already leading work with health boards to transform services and improve the quality and safety of mental healthcare." A spokesperson on behalf of Cardiff and Vale University Health Board said its focus was on providing "safe, quality and compassionate mental health support" to people across Cardiff and Vale in community and inpatient settings."Mental health services at Cardiff and Vale UHB have recently committed to a co-produced family engagement project. The aim of the project which started in April 2025, is to enhance engagement with families and carers in order to improve patient safety and patient outcomes," they said. If you have been affected by any of the issues in this story, support is available via the BBC Action Line.
