Final PBL Proposal

PCP: Rahul, Sarah, Jackie, Chloe

Our experiences
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Jackie and Sarah

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Chloe
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UC Early Learning Center

Ethical issues encountered: very few ethical issues encountered.
Judson Care Center (nursing facility)
Ethical issues encountered: inappropriate faculty-patient interaction.

Rahul
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Crossroad Health Center (in Over-The-Rhine)

Ethical issues encountered: patient-doctor relationship and information given to doctor

by patient.

The situation
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Crossroad OTR:
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Patient informed physician that he popped percs and smoked weed heavily.
- Percs= percocet
- Reference to street narcotics.
Physician took note of the drug use, but did not press the patient about stopping usage.
Instead, focused on:
- Checking the patients heavily-inflamed tonsils and referring him to a specialist.
- Informing the patient that smoking with asthma would lead to a high COPD risk.

Our prompt:
Is it ethical to ignore the patients illegal activities (ex. drug
use) when they come for a visit?

Discussion Questions
What are your initial reactions based on the prompt and situation?

Step 0: Check Values

Trust & Honesty

Awareness

As health care professionals, we want to take note of the environment and community we
are surrounded by as well as the population of that community.

Empathy

Being able to confide in others.

Foundation of a strong and positive patient-physician relationship.

Understanding the population of the patient and taking into consideration their feelings
(i.e. lack of trust) of the health care setting.

Service

As health care professionals, we want to give back to lower-income/impoverished

communities.

Step 1: Gathering Relevant Information

Crossroad Health Center
- Opened in 1992 with a mission to provide accessible, affordable, community-based primary
health care services & mental health counseling to residents of OTR and surrounding Cincinnati
communities.
- Provides primary health care to children and adults in Greater Cincinnati regardless of ability to
pay.
- Provides sliding fee scale for patients with no insurance, with a minimum co-pay of $15.
- Accepts Medicaid, Medicare, most commercial insurances, and self-pay.
- Bilingual staff for Spanish speaking patients.
- Federally qualified health center.
https://www.bphc.hrsa.gov/about/what-is-a-health-center/index.html,
crossroadhc.org

Step 1: Gathering Relevant Information

-

The patient had not been to Crossroad in 3 years.

Physician mentioned We see patients like this all the time. Drug use is
high in this area, but as physicians we must work to treat what we
reasonably can while improving the trust of the patient in us.
-

This way, patients will not feel attacked and will likely feel comfortable in coming back to
Crossroad, where physicians can help patients over time.

Physician also noted percocet is a gateway to heroin use.

Are doctors required to report these cases (e.g. illegal drug use)?
-

Ultimately, doctors are not obligated to report these type of issues.

Sharing medical information without consent is necessary when the patient seeks
medical attention, the government requires it, or the patient makes health an issue in
court.
http://healthcare.findlaw.com/patient-rights/can-doctors-give-medical-information-to-others-without-permission.html

Step 2: Identify the type of ethical problem

Ethical dilemma: complex conflict between two possible decisions. Choosing
one prevents you from achieving the other.
1.

2.

As a health practitioner, one can choose to avoid health issues of a

patient that result from illegal activities in order to attempt to build
patient-provider trust over time.
As a health practitioner, one can choose to inform all aspects of a
patients health care, in order to best treat the patient immediately.

Step 3: Analyze the problem using ethical theories

or approaches
Egoism: Individual self-interest is the actual motive of all conscious action.
By not pressing the patient on more sensitive aspects of health care (their illegal
activities), the provider builds the trust of the patient and feels confident in their
patient-provider interaction.
Utilitarianism: Greatest good for the greatest number of people.
As a healthcare provider, not pressing the patient allows for the provider to give
care to more individuals since less time would be spent per patient. It could also
ultimately make the patient trust the provider more to ultimately visit the clinic
more often.

Step 3: Analyze the problem using ethical theories

or approaches
Deontology: Rule based ethics.
In order to abide by Crossroads mission of providing comprehensive healthcare to lead
to healthy, changed lives, a healthcare provider must address all aspects of a patients
medical issues.

Crossroad mission: Our mission is to give honor to Jesus Christ by providing

accessible, comprehensive health care in partnership with our patients and community
leading to healthy, changed lives.

Virtue Ethics: Emphasize moral character of moral agent.

Through defining the healthcare provider as being the moral agent (virtuous), whatever
decision the healthcare provider makes must be trusted as being the ethical one.
crossroadhc.org

Step 4: Explore practical alternatives

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Consult another provider on the floor.

Speak with family members at the visit regarding improving the patients
unhealthy decisions.
Give the patient a brochure or pamphlet regarding their medical issues to
take home and read as necessary.

Step 5: Act
Through the framework of deontology, we (as healthcare providers) would
choose to press the patient on their illegal activities in order to best treat
them.

Step 6: Evaluate the process and outcome

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By pressing the patient regarding their illegal activities, we anticipate

achieving Crossroads mission of providing comprehensive healthcare to
all patients, leading to a changed, healthier lifestyle.
Patients would be informed of the detrimental effects of illegal activities
(i.e. drug use) on their health, and how they can fix it.

However;
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Some patients may not respond well to being lectured on these aspects of
their health and may choose not to come back to Crossroad Health
Center, thus putting them at risk for further health issues.

Step 6: Evaluate the process and outcome

Our process:
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Difficult to make a decision.

-

Seems easy to want providers to press all aspects of a patients health.

Had to consider the population Crossroad serves.
- Could already be coming in with mistrust of the healthcare system.

The deontology framework helped clarify our thoughts by focusing solely

on Crossroads mission.

Questions?

References
http://healthcare.findlaw.com/patient-rights/can-doctors-give-medical-information-to-others-without
-permission.html
http://www.crossroadhc.org/
https://www.learningtogive.org/resources/egoism
http://www.iep.utm.edu/egoism/
https://www.bphc.hrsa.gov/about/what-is-a-health-center/index.html