ethical crossroads along the way stories about medical training and psychiatry john maher md frcpc...
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ETHICAL CROSSROADS ETHICAL CROSSROADS ALONG THE WAYALONG THE WAY
STORIES ABOUT MEDICAL TRAINING AND PSYCHIATRY
John Maher MD FRCPC
Whitby Mental Health Centre, Canada
WHY TELL STORIES?WHY TELL STORIES?
“Insofar as ethics occurs in the context of human relationships, our ability to discern right from wrong and good from bad depends to a significant extent on how open we allow ourselves to be to others…
WHY TELL STORIES?WHY TELL STORIES?
By sharing and comparing stories we learn to better appreciate where our lives and experiences intersect with the lives and experiences of others.
Ethics takes place at this intersection…
WHY TELL STORIES?WHY TELL STORIES?
In a very real and important sense, the ethical landscape of each clinical encounter is subtly negotiated through shared understanding. Through sharing we cultivate empathy,and from empathy we internalize the motivation to behave toward others as we ought…
WHY TELL STORIES?WHY TELL STORIES?
Empathy is the impetus to respect, and respect is the core of ethics.
Narrative is the mechanism that brings it all together.”
Workman S, Hubert J, Byers R, Jaggi R, Jantz A;
CMAJ, May 9, 2006; 174(10), p. 1453
MALAISE:MALAISE: The feelings that guide us The feelings that guide us
1) Clinical Malaise (head)2) Moral Malaise (head/heart)3) Interpersonal Malaise (heart)4) Freudian Malaise (heart of hearts)5) Spiritual Malaise (heart and soul)
Medical SchoolMedical School
What I knew before I got there…
PhilosophyMedical EthicsHealth ServicesHealth Policy
Medical SchoolMedical School
“Are you Christian?”“Medical Student” or “Student Doctor”?“Hello Dearie”“Do you drink a lot of alcohol?”My policy beliefsGo along to get along…
ClerkshipClerkship
Exhaustion, stress, codesA fair call schedule“Jump on him!”Stat to surgeryCARMS
Year 1 – Rotating InternshipYear 1 – Rotating Internship
Black Day in JulyDifferent strokes for…Post-kidney transplantPronouncing death
Year 1 – Rotating InternshipYear 1 – Rotating Internship
A problem with blood pressureAbortion clinic“Butcher B.” and the truthA supervisor’s woes
YEARS 2 to 5 - RESIDENCYYEARS 2 to 5 - RESIDENCY
9 years in 5Growing autonomyEssential paternalismCertifying someoneSaudi perspectives
YEARS 2 to 5 - RESIDENCYYEARS 2 to 5 - RESIDENCY
Attitudes towards BPDSerge was beat upChanging a report after a suicideA mercenary’s storyBeing Chief ResidentFITRENot invited back
IN PRACTICEIN PRACTICE
Informal opinion:
“Do I need to see a doctor?”Pill exchange“I want my gun back”Alcohol and harm reductionDrug company money
IN PRACTICEIN PRACTICE
Nurse accused of assaultInadequate response to suicide attempt“Dreams”, hit and run, assaultHit man & a disability applicationA colleague refusing consultsACT Team
AND THE STORY AND THE STORY CONTINUES…CONTINUES…
Where are the heroes of bioethics? (Freedman)
C.S. Lewis, The Great Divorce, and the real heroes…
Going on safari…