Show Me the Money

Patient case studies are used to foster the development of professionalism and the exploration of ethical resolution to medical dilemmas. Typically, they are text-based and relate to current headline issues like euthanasia, abortion, and organ transplantation. But, as newsworthy and interesting as these issues may seem, many students complain that most case studies lack any relevancy to their own specific needs or future plans of practice.

Case study analysis is a valuable learning tool because it provides students the opportunity for self-reflection, interaction with peers, and "higher order” thinking skills. The learning process begins with self-reflection, and that is motivated by relevancy. In a world of increasing medical specialties, subspecialties, and sub-subspecialties, students ask, "Why should I care?” Students demand, "Show me the money!” In fact, some students question the whole notion of learning about medical ethics because their face-to-face relationship with patients will be limited or fleeting at best. For the medical educator, it is challenging to demonstrate relevancy. Usually, the medical educator can take two basic approaches to meet this challenge: 1) Convince students that some issues are significant to public health and welfare, no matter what the medical specialty, or 2) Use case studies that are relevant to the (future) practice of the student. Lately, I find myself doing more and more of the latter, and discovering that it increases the opportunity for self-reflection: the first step in learning new values, attitudes and behaviors.

I can understand why some students don’t see the need to research, discuss, and analyze the ethical ramifications of unconventional practices such as human cloning. Cloning is science fiction for students who will spend their working hours drawing blood, interpreting scans, or preparing patients for surgery. So, I’ve eliminated assignments on cloning as irrelevant for most of my students (leaving it as a final project option for those students who may be interested in researching the topic on their own). However, the same argument isn’t valid for eliminating other topics. For example, a case study that questions the first-come-first-served rule for organ transplantation may seem irrelevant to those who won’t be involved in the decision-making process. Regardless, it is the medical educator’s task to show how an issue is relevant, even though students cannot envision themselves personally involved in the decision-making processes. This can be accomplished by showing them the "money.” In the case of the first-come rule, students can explore different emergency and clinical triage processes or they can be asked to donate some blood and then decide between potential patients to determine who may be the most worthy recipient. Even still, there may be some students who remain apathetic because they are convinced that, at best, their professional roles will be no more than "technicians.”

I suppose some of the same students complain about having to learn how to conduct research or write a paper that is suitable for publication – where’s the money? As an ethicist, it is difficult for me to understand how any aspect of the human condition isn’t interesting, especially to someone who will be providing health care. But, as a teacher, it is inevitably up to me to find relevant information and resources so that students will see the "money” and be motivated to dig deeper and expand their understanding of ethical healthcare practice. It takes vigilance and motivation on the teacher’s part, who may need to alter his or her approach, venture outside of the course text, and replace some of their personal favorite case studies with ones that students will find more relevant. For example, the following case study may not be in the course text, but it has relevance, even to those who view their chief role as a "technician.”

Ritchie, who is a clinical perfusionist (a certified medical technician who monitors the heart-lung bypass machine) was fired for texting while in surgery. Ritchie claimed he was merely "multitasking” and that doctors and nurses often asked him to text messages to their offices or retrieve online information. Several nurses reported that Richie shared weather forecasts and football scores with the OR staff, but that he was often on Facebook or checking emails. Other doctors and nurses at the hospital defend the use of electronic devices, claiming that they are important tools that can be used to reduce medical error. What do you think? Is there a conflict between focusing on gadgets and focusing on patients, or does the benefit outweigh the risk? How might you go about designing a policy for their ethical use?

The study of medical ethics has to be relevant in order to initiate self-reflection and foster higher levels of learning and professional development. Relevant case study analysis gives practical value to lofty ethical ideals such as beneficence and nonmaleficence, and answers the call to "show me the money!”


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