2008 John Conley Ethics Essay Contest Scenario and Instructions for Entering

Scenario

Dr. Montgomery is a member of an internal medicine group practice in Minneapolis. The group accepts patients covered by a variety of private and public payers. Because population is fairly stable in Minneapolis, Dr. Montgomery and many of his patients have had the good fortune to establish long-term patient-physician relationships, in which they can work on prevention and chronic disease management.

A case in point is Mr. Carson. Dr. Montgomery has been caring for Mr. Carson for almost five years. Mr. Carson has been with the same employer since he began visiting Dr. Montgomery and has employer-sponsored insurance benefits for himself and his family. Dr. Montgomery has been helping Mr. Carson manage his non-insulin-dependent diabetes and his weight. Mr. Carson also has hypertension and high cholesterol.

At Mr. Carson's three-month check-up, Dr. Montgomery was surprised to see his patient's BP at an uncharacteristically high 165/90. When he asked what Mr. Carson thought was responsible for the jump, Mr. Carson said that he had only been taking his blood pressure medicine sporadically in the last few months.

“Why is that?” asked Dr Montgomery.

“Well, we've had this new wellness program at the job,” said Mr. Carson. “Started almost a year ago, now. We had to fill out a ‘lifestyle profile'—did we wear seat belts? How much alcohol did we drink? Did we smoke? How much did we weigh? A whole bunch of stuff like that.”

“That doesn't sound like an altogether bad idea. What does it have to do with your blood pressure medication? ” Dr. Montgomery asked.

“Well, whoever looks over these things at the insurance company decided that I should lose weight, at least 10 pounds over 6 months. I couldn't do it, doc. You know how hard I've tried and all the plans we've worked out for exercise and the like. I tried, but I ended up actually gaining a few. So now I have to pay $50 more for my health insurance every month until I get my weight down. I can't pay for that and buy all this medicine, too. My wife and I talked it over and we figured out that it's more important to take those two kinds of diabetes pills. That's right, isn't it, doc? I don't' get feeling bad from the blood pressure like I do when my sugar's out of whack.”

Instructions for Entering

Essays should explore arguments for and against use of financial penalties to encourage healthy lifestyles and consider how such policies may affect the care that individual physicians are able to provide.

Essays will be judged on their applicability to the scenario, thoroughness of analysis, and clarity of presentation. The author of the best essay will be awarded $5,000, and the winning essay will be published in Virtual Mentor. Up to three honorable mention awards of $1,000 each will be granted. Essays must not have been previously published in print or electronic format and must not be submitted for consideration to any other journal during the review period.

All current medical students are eligible. Essays must be 2,000 words or fewer. Submit essays typed and double spaced, with the author's identification (name, address, telephone number, e-mail address, and medical school class) on a cover sheet only—not on the essay pages. Entries must be received as e-mail attachments by midnight CDT, July 15, 2008. Submit essays to Faith.Lagay@ama-assn.org.

For more information about the contest and to read previous essays that have won, go to John Conley Ethics Essay Contest for Medical Students.