AMA Journal of Ethics^®

Case

“Hello, this is Bob,” the doctor said as he answered his cell phone after digging it out from underneath his couch cushions.

“Bob,” the voice responded, “this is Jackson.”

“Oh, Jackson—great, this reminds me,” Bob replied while muting the volume on the football game. “Bryan's mom called this evening right after you left, and Bryan seems to have acquired another respiratory infection. I called in a refill on his antibiotics for the evening and scheduled him for you as an emergency appointment first thing tomorrow. I know with the avian flu going around the last thing you want is for one of your kids with cystic fibrosis to get pneumonia.”

There was a pause on the other end. “Yeah, well, that’s why I’m calling actually,” Jackson said. “Look Bob, I know we’ve been in practice together for a long time and it’s been great, truly it has. I mean you’re Emily’s godfather after all. The thing is, with this avian flu mess…” His voice trailed off.

“Jackson?” Bob asked, puzzled. “What are you trying to say?”

“What I’m trying to say, what I know I have to explain to you and Christine as my partners, is that I’m just not comfortable staying in the city if this is the beginning of an epidemic. Cathy and I are taking the kids to her parents tomorrow. We’re driving, staying away from the airports and everything. I’m sorry Bob, but this is looking serious. And at some point I have to start putting my own kids first. Like I said, I’ve already talked to Christine—can you 2 cover for me?”

Commentary 2

Physicians hold a special position in our society and, at a time of a potential medical crisis, we need to give society our best effort—not turn and run. In the case of a developing infectious epidemic for which evacuation is considered, physicians may want their families to leave in a reasonable and proper manner for a safer location. Furthermore, the evacuation of areas of potential crisis—a region with impending hurricane landfall, for example—is also an accepted means of balancing public health in a crisis situation. In either setting, however—epidemic or evacuation—medical professionals need to be available to provide appropriate care for our patients.

The physician in this case has chosen to leave the scene of an epidemic and is shifting the responsibility of caring for his patients to his partners. Something must be said here about “dumping” on one’s associates. Deserting one’s physician colleagues during a crisis and asking them to do what you do not wish to do places an unfair portion of the burden for fulfilling the profession’s promise to society on select members.

Running foolishly into a situation that is known to be dangerous is not wise and is not suggested. On the one hand, the physicians facing a potential epidemic should not needlessly put themselves at risk by failing to observe appropriate precautions. On the other hand, physicians have a professional duty to stay to help in a coordinated and rational fashion during times of crisis. As members of a team functioning in a calm and intelligent fashion, we can work to balance these competing interests—protecting physicians as much as possible while helping our society in time of medical need.

Crisis Plans and the Local Physician

Crisis plans have a role to play in these situations. The plans are constructed to facilitate the logistical management of a medical crisis such as an emerging infectious disease. We hope the “worst-case” scenario never occurs, but if necessary, a crisis plan prepared in advance can be implemented. Most crisis plans are designed by the Centers for Disease Control, Red Cross, and other large government and private agencies so that central controlling agencies can coordinate a widespread effort. As a result, private practice physicians are not commonly involved with crisis planning, but when a potential crisis is on the horizon, medical professionals should contact the local authorities and make themselves available. Local physicians who know the city, the clinics, the hospitals, and other local professionals are invaluable for the coordination of care in an area facing a crisis such as the one described in this clinical case. As a primary care physician I can be available for triage, education, immunization, initial diagnoses, and primary treatment. Depending on training, physicians in other specialties can be available for consultations or secondary and tertiary care. If local physicians don’t address medical needs, the severity of the crisis is exacerbated.