Ethics 101: The Doctor Is Out To Dinnerby JC, MD | June 6, 2008
In an effort to make this blog more interactive, I’ve decided to start a new series of posts focusing on Ethics and Medicine. In this series I will post a series of cases and see what my readers think. Some of these will focus on the ethics of the doctor, some the patient, the hospital, and other the health care system in general. I hope you enjoy the series and feel free to let me know what you think.
In a fit of rage, a thirty year old otherwise healthy man punches a hole through his window. He’s been arguing with his girlfriend over the telephone and finally loses his cool. He bleeds profusely from his arm and there are obvious glass shards stuck in his skin. He drives to the local ER because he is worried that he has done some serious damage to his hand.
Upon evaluation in the ER, the Emergency Physician documents that he has some numbness in his ring and pinky fingers. He is also not able to bend those fingers much. A X-ray does not show any broken bones but you can see glass shards under the skin. The ER physician is worried because he can’t see the glass sticking out of the skin. He also believes that the patient has lacerated some tendons and maybe even nerves. Thus he feels that a hand surgeon should be consulted. Unfortunately, there is no hand surgeon in the community that takes on-call service for the ER. Thus, the ER doctor calls various community hand surgeons to see if they will take care of the patient.
Finally, the ER is able to get a hand surgeon who will answer his pager. The hand surgeon agrees to get involved with the care of the patient. He listens to the story over the telephone and feels in his best judgment that the patient will need an exploration of his hand in the operating room. Studies show that there is no difference whether this happens sooner or later as long as it is done within 24 hours. Thus he explains to the ER doctor that he is out to dinner with his family and won’t be able to see the patient until the morning. He tells the ER physician to either discharge the patient and have him come to his office in the morning, or to admit the patient and that he will see the patient in the morning.
There are many ethical questions here:
- Should the hand surgeon come to the ER to evaluate the patient to confirm the diagnosis in an emergent manner?
- Should the ER even accept to evaluate patients with injuries for which they have no specialists to treat?
- Should the hospital even allow the hand surgeon to have hospital privileges even though he refuses to take ER call?
- Does the average patient believe this is acceptable care?
Mental Context – A Delicate Subject
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