Virtual Mentor

Virtual Mentor. July 2012, Volume 14, Number 7: 527-598.

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July 2012 Contents

The Ethics of Shared Decision Making

Ethics Poll

Cardiac resuscitation is unlikely to provide any benefit for a patient with multiple organ failure who will die shortly from those failures. In such a case, do you think it is helpful for physicians to make the "do not resuscitate" decision and allow the patients' surrogates to accept the physicians' judgment without asking for explicit consent from the surrogates?
Yes. Physicians know more about what interventions will be futile and their decision makes the situation less traumatic for the patients' surrogates.
No. This practice ignores the surrogates' right to make decisions for the patient and could be abused to save money and resources.
Don't know.

Do you think that receiving statistical information about the probability of risk is helpful in medical decision making? Select the answer that best describes what you think.
Yes. I would want to receive such information; it helps me to know "the odds."
Sometimes. I would only want to receive such information when there was a wide margin between probability of risk and benefit, e.g., 80 percent survival versus 20 percent mortality.
No. Statistics have no relevance in a specific case, so the information is useless.
No. I would rather have the physician explain in nonstatistical language his or her experience with other patients' outcomes.

Many drugs approved by the FDA are used to treat conditions other than the condition they were approved to treat. This practice is called "off-label use." Do you think patients should be informed and explicitly asked for their consent when a physician intends to use a drug "off label"? Select the answer that best describes what you think.
Yes. Not telling patients ignores their right to give informed consent to treatment.
Yes. If patients had to give consent to off-label use, maybe drug companies would go back and test the drugs for the new uses.
Yes. Patients should not have to pay for a drug that has not been shown in randomized trials to be effective for the specific condition they have.
No. FDA approval means the drug is safe, so a drug that has FDA approval won't do the patient any harm.
No. I trust my physician’s knowledge of pharmaceuticals and experience in using them.

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From the Editor

Transforming the Patient-Physician Relationship: The Future of Shared Decision Making
Claire K. Ankuda
Full Text | PDF
Virtual Mentor. 2012; 14:529-531.

Educating for Professionalism

Ethics Cases

Discounting a Surgical Risk: Data, Understanding, and Gist
Commentary by Peter H. Schwartz
Full Text | PDF
Virtual Mentor. 2012; 14:532-538.

When Patients Seem Overly Optimistic
Commentary by Jane deLima Thomas
Full Text | PDF
Virtual Mentor. 2012; 14:539-544.

The Use of Informed Assent in Withholding Cardiopulmonary Resuscitation in the ICU
Commentary by J. Randall Curtis
Full Text | PDF
Virtual Mentor. 2012; 14:545-550.

Medical Education

Investing in Each Other—Balint Groups and the Patient-Doctor Relationship
Steve Crossman
Full Text | PDF
Virtual Mentor. 2012; 14:551-554.

The Code Says

The AMA Code of Medical Ethics’ Opinions on Informing Patients
Full Text | PDF
Virtual Mentor. 2012; 14:555-556.

Journal Discussion

Exploring Physicians’ Attitudes about and Behavior in Communicating with Patients
Sorcha A. Brophy
Full Text | PDF
Virtual Mentor. 2012; 14:557-559.

State of the Art and Science

Do Patient-Accessible Electronic Medical Records Help Or Complicate Shared Decision Making?
Steven D. Freedman and Camilia R. Martin
Full Text | PDF
Virtual Mentor. 2012; 14:560-562.

Law, Policy, and Society

Health Law

Informed Consent: What Must a Physician Disclose to a Patient?
Bryan Murray
Full Text | PDF
Virtual Mentor. 2012; 14:563-566.

Policy Forum

Vermont's Single-Payer Health Care System: An Interview with Allan Ramsay
Claire K. Ankuda
Full Text | PDF
Virtual Mentor. 2012; 14:567-570.

Medicine and Society

The Role of Perception in Quality Communication
Judith A. Hall
Full Text | PDF
Virtual Mentor. 2012; 14:571-575.

Op-Ed and Correspondence

Op-Ed

Informed Consent for Off-Label Use of Prescription Medications
Zain Mithani
Full Text | PDF
Virtual Mentor. 2012; 14:576-581.

Selective Paternalism
Brian C. Drolet and Candace L. White
Full Text | PDF
Virtual Mentor. 2012; 14:582-588.

Resources

Suggested Readings and Resources
PDF
Virtual Mentor. 2012; 14:589-596.

About the Contributors
Full Text | PDF
Virtual Mentor. 2012; 14:597-598.