In medical school the medical ethics class was one of the least popular classes because it was the most difficult. It requires more than first level thinking where it is just gathering information and remembering facts. It involved second and even third level thinking with interpretation, analysis and application. No multiple choice here. Given the importance I found it somewhat disturbing that it was one of the shortest classes and few A’s were earned.
I think it is important that as a patient you understand the four ethical pillars of medical decision making. I find them very well designed and as true today as when physician Thomas Percival published them in 1803 and later adopted by the American Medical Association in 1847. All 4 of the pillars are of equal importance and weight when placing them on the scales of medical counsel. With this in mind, lets jump right into the 4 pillars:
- Beneficence Simply put, it means practicing medicine with the intention of doing good for the patient. It requires a physician to develop new methods, maintain old skills, and stay up with current medical knowledge. The physician must consider the individual’s circumstance in making medical recommendations.
- Non-maleficence Essentially, strive to do no harm to an individual patient or society as a whole. When making a medical decision a physician must account for the patient’s complete well-being including the physical, mental and emotional health of the person. And on occasions when others may also be impacted by the decision then consideration must be given to them as well.
- Justice Treat all patients fairly, impartially and equally. This is especially true in society when there exist scarce or limited resources such as investigational treatments and where there is unequal access to medical care.
- Autonomy Respect a patient’s right to self-determination. The patient should have the right to make his/her own decision that is fully informed and free of coercion and coaxing. The physician’s role is to counsel and advise not to judge and force.
A physician should base his/her analysis of options and recommendations on the first three pillars but the ultimate decision is given to the patient respecting the fourth pillar. The practice of medicine is still an art and not an exact science if we physicians are truly operating under the code of medical ethics. Practicing medicine through the eyes of these four pillars is not easy in a world of complex circumstances and I hope we never lose sight of these guiding principles.
Full disclosure: Medical Ethics was one of my favorite classes and one of my fondest A grades. – Dr. B
Seasonal Allergies
The dreaded allergy season is here. Runny nose, itchy eyes, sneezing – misery! Allergies are caused by allergens which are glycoproteins specific for a certain substance like oak pollen. A person will develop allergies if their immune system recognizes an allergen as something foreign and not belonging. It responds by producing IgE type antibodies which causes the release of histamines from mast cells and other immune mediators that cause the “IgE mediated” immune response in an attempt to rid the body of the foreign substance. Essentially, trying to flush it out of the system with nasal drip and runny eyes or expel it out with a good sneeze or three.
Allergies are more common in children (about 40%) versus adults (25-30%) and a person can develop allergies at any time in their life although a lot of children “grow out” of allergies but adults in their 20’s and 30’s often do not. However, allergies tend to get better as we get older and can wax and wane in severity throughout a lifetime with intermittent severe Seasonal Allergies allergy years intermixed with minimal or no allergy years. As with many health conditions genes play a role so if one or both parents have allergies this increases the likelihood of developing allergies but it does not guarantee it as fait accompli.
All year round, or “perennial”, allergies are usually from dust mites, cockroaches or pet dander (cats are much more allergenic than man’s best friend). Seasonal allergies are commonly pollen antigens from trees in the spring, grasses in the summer and ragweeds in the fall. Mold is sort of both perennial and seasonal since it flourishes in humidity and damp areas but typically it is dormant in the cold, dry air of winter. You can be allergic to one thing or many things, so often, when a person thinks their allergies are getting worse, it means they just added a new allergy to their immune arsenal. For avoidance measures and treatment see my website knowledge center Allergy Season 101
Sarah’s Weight Management Corner
The key to long term success with weight loss is not discipline or will power but the ability to create true behavioral change. To take the decision making process from the conscious to the subconscious and make it instinctive, the change needs to be deliberate, practical, and nurtured. Decide – Plan – Act – Reinforce. An effective plan is the most important factor and why less than 10% achieve success. Failing to plan is planning to fail.
John’s Healthy Lifestyle Corner
When shopping to eat healthier choose less processed foods. If it is in a can, bag, wrapper, container, jar or box then it is processed. Some foods like bagged or cut veggies are minimally processed but most foods like ice cream and frozen entrees are heavily processed with added ingredients like fats, salt and sugar which subtract from the nutritional quality and value. Avoid the inner halls, shop the outer walls.
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