Virtual Mentor

2014 Conley Ethics Essay Scenario

Jake arrived home from the hospital and said to his wife, Emma, "How should I deal with this?" waving several sheets of paper in the air before letting them drop on the desk where Emma was working. "It's a 360-degree performance evaluation of interns, so theyíre asking interns to evaluate their peers."

"Glad we don't have that in the surgery department." Emma said. "You medicine docs are so . . ."

"Yeah, yeah. I know what we are. That doesn't help me. I've got to rate Alex's performance, and Iím not even certain how I feel about what he does, let alone how to complete this evaluation."

Jake and Alex were interns in Riverside Hospital's internal medicine residency program. Emma was an intern in surgery at the same hospital. Jake and Emma had entered the match as a couple and were pleased to have landed slots at Riverside. But almost since day one, Jake had complained to Emma about Alexís way of doing things. At first, Jake had chalked it up to the enormous difference between being a med student and being an MD. In the beginning, it was a challenge for interns to retrieve the needed clinical facts in a moment's time and to manage the overwhelming amount of work in the closely monitored shift time.

That was six months ago. Now Alex's "style" (Jake thought that was a neutral way of putting it) was more than annoying, and Jake was resentful. Whenever Alex signed out to Jake, Jake would be faced with a long patient-related "to-do" list that Alex had not completed before his shift came to a close: check and enter lab results for Patient A; accompany Patient B to CT imaging; follow up with Dr. C who did the pulmonary consult for Patient D; enter more complete chart notes for Patients E and F. Jake was behind before he began. He never got to the list of tasks he needed to perform with and for his patients.

Alex was not incompetent; he knew his stuff, had good rapport with patients, and was liked by patients and staff. The one time Jake had mentioned his distress over the amount of work Alex left behind, Alex had said in a friendly enough way, "Hey, ya know, I work hard during my 8 hours on, spend time with my patients, and get as much done as I can. I didn't set these work hours, but I have to stick to them. You should look at it that way, too, man. Work hard, do what you can, and pass the rest on. That's obviously what they want these days. They're not asking us to be 24/7, superhuman doctors anymore." As he walked away, Alex had said, "Get a life, Jake."

"Signing out such a long to do list wouldn't be tolerated by surgery housestaff," Emma said, raising an eyebrow. "So what are you going to do?"

Emma heard Jake mumble, "About Alex or about myself?"

Instructions for Submission of Essays

Resident work-hour restriction were put into place slightly more than a decade ago to improve patient safety and to humanize a longstanding professional norm that physicians had, in fact, no life beyond the practice of medicine; being a doctor defined the person. Some say this intent to humanize the profession has had consequences that are turning the practice of medicine into just another job. In responding to this scenario, think beyond the immediate question of how Jake should evaluate Alex or change his own behavior and explore the larger question: has the attempt to strike a better work/life balance gone too far? Are its consequences good or bad for medicine? For patients?

Students who are currently enrolled in US medical schools are eligible to submit essays for consideration. Essays must be 2,000 words or fewer, excluding references. They must be typed and double-spaced, with the authorís name, address, telephone number, e-mail address, and medical school and class on a cover sheetónot on the essay pages; authors will be anonymous to the judges. Essays must be received as one e-mail attachment in Word, using the authorís last name as the filename. All entries must be submitted by 5 pm CDT, July 31, 2014 to Kelly Shaw at kelly.shaw@ama-assn.org.