Ethics Talk

Over the past decade there have been numerous stories about overcrowded ERs. One way many communities addressed such overcrowding was to divert ambulances away from overcrowded hospitals to less busy ones that had available room and resources to treat patients. In Jan 2009, Massachusetts became first state to successfully ban the practice of ambulance diversion. Virtual Mentor spoke with Dr. Stephen Epstein of Harvard Medical School about the Massachusetts ban and what other communities can learn from one state's experience.

Cosmetic surgery is a hotly debated issue in our society. Is it a consumer good or a medical procedure? Should elective procedures be taxed? Does plastic surgery promote oppressive norms of beauty? Virtual Mentor asked six "people on the street" in Chicago for their views about the personal and social effects of elective cosmetic surgery.

Despite the fact that the majority of Americans are now medically defined as overweight, stigma against individuals who are obese remains a widespread phenomenon. Virtual Mentor asked Dr. Rebecca Puhl, Director of Research and Anti-Stigma Initiatives at the Rudd Center for Food Policy and Obesity at Yale University to comment on the prevalence in our society and in health care and what can be to help ameliorate it.

Some physicians believe that knowing about patients' religious and spiritual beliefs helps them care for the whole person. There is even evidence that patients who are part of faith traditions and attend services regularly are healthier. Other physicians believe medicine and religion should be kept separate, and encourage their patients to talk to a chaplain for spiritual support in times of suffering. This interview with a physician-theologian, medical student, and patient explores a range of perspectives on what has become a hotly debated topic. To read more about the role of spirituality in patient care, see the October 2009 issue of Virtual Mentor at www.journalofethics.org

For somewhere between $200 and $2,000, curious individuals can sign up with an Internet service, send in a drop of saliva or some cheek cells and receive a report on their ancestry and their predisposition to a number of medical conditions from type 2 diabetes to baldness or back pain. "Ethics Talk" interviewed two people who used the online service for very different reasons. To read more about genetic testing and information, see the September 2009 issue of Virtual Mentor at www.journalofethics.org.

Fewer medical students are selecting primary care specialties such as family medicine and pediatrics, a trend which could cause a shortage in the types of physicians society needs most. Two medical students explain the reasons for their choices of specialty and comment on possible reasons for the trend.

Today's patients are better informed about possible causes and treatments for their symptoms than ever before. A physician works through a challenging encounter with a patient who comes to her office demanding a particular brand name drug and will accept nothing less--or so it seems at first.

Graduating medical students still report being belittled and mistreated by their instructors and clinical faculty. Two medical students and a resident physician discuss this phenomenon and the procedures that all accredited medical schools have in place for responding to student reports of mistreatment.

More and more employer-based insurance plans are using incentives and penalties to encourage healthy lifestyle choices among those they insure. Sometimes these wellness programs employ "carrots" and "sticks" that limit benefits or charge more for coverage. A company benefits representative, health insurance executive, and a physician discuss the new trend in wellness programs and how they affect patients, the patient-physician relationship, and employers. To read about this dilemma in detail, see the November 2008 issue of Virtual Mentor at www.journalofethics.org.