The Cases of "Delivering Bad News" That Observed on Clinical Internships: Student's Experience
Yıl 2024,
Cilt: 11 Sayı: 3, 104 - 109, 27.09.2024
Sibel Cevahir
Öz
Medical education aims to prepare students for the profession. The importance of clinical experiences and observing role models in cultivating clinical-ethical decision-making skills is undeniable. This article explores a medical student's observations and reflections on the process of delivering bad news during clinical internships. Observations and questions arising from four specific cases are presented, followed by an analysis identifying the factors that prompted these questions. The cases are then discussed within the ethical framework of delivering bad news. Finally, recommendations for clinical ethics education are provided.
Kaynakça
- Aslan D, Odabaşı O. Tıp Eğitiminde “Mentorluk” ve “Rol Modelliği” Kavramları. TED 2013; 38 (38): 43-49.
- WMA-The World Medical Association. WMA Statement on medical education [Internet]. WMA-the World Medical Association; 2020 [Erişim Tarihi: 20.08.2020] Erişim adresi: (https://www.wma.net/policies-post/wma-statement-on-medical-education/).
- Feudtner C, Christakis DA, Christakis NA. Do clinical clerks suffer ethical erosion? Students’ perceptions of their ethical environment and personal development. Academic Medicine 1994; 69 (8): 670–679.
- White CB, Kumagai AK, Ross PT, et al. A qualitative exploration of how the conflict between the formal and informal curriculum influences student values and behaviors. Academic Medicine 2009; 84 (5): 597–603.
- Sokol DK. William Osler and the jubjub of ethics; or how to teach medical ethics in the 21st century. Journal of the Royal Society of Medicine 2007; 100: 544–546.
- Kavas MV, Işıl Ülman Y, Demir F et al. The state of ethics education at medical schools in Turkey: Taking stock and looking forward. BMC Medical Education 2020; 20 (1): 1–15.
- Souza AD, Vaswani V. Diversity in approach to teaching and assessing ethics education for medical undergraduates: A scoping review. Annals of Medicine and Surgery 2020; 56: 178-185.
- Lehmann LS, Sulmasy LS, Desai S. Hidden curricula, ethics, and professionalism: Optimizing clinical learning environments in becoming and being a physician: A position paper of the American college of physicians. Annals of Internal Medicine 2018; 168 (7): 506-508.
- Bickel J. Medical students’ professional ethics: Defining the problems and developing resources. Academic Medicine 1991; 66 (12): 726-729.
- Yıldız Ayvaz M, Karadağ ÖE, Gür G, ve ark. Sağlık Alanında Eğitim Gören Öğrencilerin Etik Duyarlılık Düzeyleri ve Etkileyen Faktörler. STED / Sürekli Tıp Eğitimi Dergisi 2024; 32 (5): 350-355.
- Dwyer J. Primum non tacere: An ethics of speaking up. The Hastings Center Report 1994; 24 (1): 13-18.
- Schwappach D, Sendlhofer G, Kamolz LP, et al. Speaking up culture of medical students within an academic teaching hospital: Need of faculty working in patient safety. PLoS ONE 2019; 14 (9).
- Okuyama A, Wagner C, Bijnen B. Speaking up for patient safety by hospital-based health care professionals: A literature review. BMC Health Services Research 2014; 14: 61-68.
- Wei̇ner S. What informed consent really means [internet]. AAMC-Associ̇ati̇on Of Ameri̇can Medi̇cal Colleges; 2019 [Erişim tarihi: 24.01.2019]. Erişim adresi: (https://www.aamc.org/news/what-informed-consent-really-means).
- Varkey B. Principles of clinical ethics and their application to practice. Medical Principles and Practice 2021; 30: 17–28.
- Thomsen OO, Wulff HR, Martin A, Singer PA. What do gastroenterologists in Europe tell cancer patients? The Lancet 1993; 341: 473-476.
- Mystakidou K, Liossi C, Vlachos L, et al. Disclosure of diagnostic information to cancer patients in Greece. Palliative Medicine 1996; 10 (3): 195-200.
- Özdoğan M, Samur M, Artaç M, et al. Factors related to truth-telling practice of physicians treating patients with cancer in Turkey. Journal of Palliative Medicine 2006; 9 (5): 1114-1119.
- Erer S, Atıcı E, Demirhan Erdemir A. The views of cancer patients on patient rights in the context of information and autonomy. Journal of Medical Ethics 2008; 34 (5): 384-388.
- Elger BS, Harding TW. Should cancer patients be informed about their diagnosis and prognosis? Future doctors and lawyers differ. Journal of Medical Ethics 2002; 28 (4): 258–265.
- Shahidi J. Not telling the truth: Circumstances leading to concealment of diagnosis and prognosis from cancer patients. European Journal of Cancer Care 2010; 19: 589-593
- Tuckett AG. Truth-telling in clinical practice and the arguments for and against: A review of the literature. Nursing Ethics 2004; 11 (5): 500-513.
- Zolkefli Y. The ethics of truth-telling in health-care settings. Malaysian Journal of Medical Sciences 2018; 25 (3): 135-139.
- Harbishettar V, Krishna K, Srinivasa P, et al. The enigma of doctor-patient relationship. Indian Journal of Psychiatry 2019; 61 (4): 776-781.
- Davies B. The right not to know and the obligation to know. Journal of medical ethics. 2020; 46 (5): 300–303.
- Peterson K. Informed refusal: A patient’s right? Nursing 2022; 52 (9): 15-20.
Klinik Stajlarda Gözlemlenen "Kötü Haber Verme" Vakaları: Öğrenci Deneyimi
Yıl 2024,
Cilt: 11 Sayı: 3, 104 - 109, 27.09.2024
Sibel Cevahir
Öz
Tıp eğitimi öğrencilerini kliniğe hazırlamayı amaçlar. Dolayısıyla tıp eğitiminin bir parçası olan etik ilkelere uygun klinik karar verme becerisinin kazanılmasında klinik deneyimler ve rol modelleri gözlemlemenin önemi tartışılamaz. Bu makalede bir tıp öğrencisinin klinik stajlarda kötü haber verme sürecine ilişkin gözlemleri ve düşünceleri aktarılmıştır. Bu amaçla dört vaka üzerinden yapılan gözlemler ve oluşturulan sorular sunulmuştur. Ardından bu soruları oluşturan nedenlere ilişkin bir durum değerlendirmesi yapılarak vakalar kötü haber verme sürecinin etik gerekçeleri çerçevesinde tartışılmıştır. Son olarak klinik etik eğitimine ilişkin öneriler sunulmuştur.
Teşekkür
Bu yazının bir kafa karışıklığından fazlasına dönüşmesinde ve somutlaşmasındaki tüm desteği, eşsiz yardımları ve akıl hocalığı için sayın Doç. Dr. Aslıhan Akpınar’a teşekkür ediyorum.
Kaynakça
- Aslan D, Odabaşı O. Tıp Eğitiminde “Mentorluk” ve “Rol Modelliği” Kavramları. TED 2013; 38 (38): 43-49.
- WMA-The World Medical Association. WMA Statement on medical education [Internet]. WMA-the World Medical Association; 2020 [Erişim Tarihi: 20.08.2020] Erişim adresi: (https://www.wma.net/policies-post/wma-statement-on-medical-education/).
- Feudtner C, Christakis DA, Christakis NA. Do clinical clerks suffer ethical erosion? Students’ perceptions of their ethical environment and personal development. Academic Medicine 1994; 69 (8): 670–679.
- White CB, Kumagai AK, Ross PT, et al. A qualitative exploration of how the conflict between the formal and informal curriculum influences student values and behaviors. Academic Medicine 2009; 84 (5): 597–603.
- Sokol DK. William Osler and the jubjub of ethics; or how to teach medical ethics in the 21st century. Journal of the Royal Society of Medicine 2007; 100: 544–546.
- Kavas MV, Işıl Ülman Y, Demir F et al. The state of ethics education at medical schools in Turkey: Taking stock and looking forward. BMC Medical Education 2020; 20 (1): 1–15.
- Souza AD, Vaswani V. Diversity in approach to teaching and assessing ethics education for medical undergraduates: A scoping review. Annals of Medicine and Surgery 2020; 56: 178-185.
- Lehmann LS, Sulmasy LS, Desai S. Hidden curricula, ethics, and professionalism: Optimizing clinical learning environments in becoming and being a physician: A position paper of the American college of physicians. Annals of Internal Medicine 2018; 168 (7): 506-508.
- Bickel J. Medical students’ professional ethics: Defining the problems and developing resources. Academic Medicine 1991; 66 (12): 726-729.
- Yıldız Ayvaz M, Karadağ ÖE, Gür G, ve ark. Sağlık Alanında Eğitim Gören Öğrencilerin Etik Duyarlılık Düzeyleri ve Etkileyen Faktörler. STED / Sürekli Tıp Eğitimi Dergisi 2024; 32 (5): 350-355.
- Dwyer J. Primum non tacere: An ethics of speaking up. The Hastings Center Report 1994; 24 (1): 13-18.
- Schwappach D, Sendlhofer G, Kamolz LP, et al. Speaking up culture of medical students within an academic teaching hospital: Need of faculty working in patient safety. PLoS ONE 2019; 14 (9).
- Okuyama A, Wagner C, Bijnen B. Speaking up for patient safety by hospital-based health care professionals: A literature review. BMC Health Services Research 2014; 14: 61-68.
- Wei̇ner S. What informed consent really means [internet]. AAMC-Associ̇ati̇on Of Ameri̇can Medi̇cal Colleges; 2019 [Erişim tarihi: 24.01.2019]. Erişim adresi: (https://www.aamc.org/news/what-informed-consent-really-means).
- Varkey B. Principles of clinical ethics and their application to practice. Medical Principles and Practice 2021; 30: 17–28.
- Thomsen OO, Wulff HR, Martin A, Singer PA. What do gastroenterologists in Europe tell cancer patients? The Lancet 1993; 341: 473-476.
- Mystakidou K, Liossi C, Vlachos L, et al. Disclosure of diagnostic information to cancer patients in Greece. Palliative Medicine 1996; 10 (3): 195-200.
- Özdoğan M, Samur M, Artaç M, et al. Factors related to truth-telling practice of physicians treating patients with cancer in Turkey. Journal of Palliative Medicine 2006; 9 (5): 1114-1119.
- Erer S, Atıcı E, Demirhan Erdemir A. The views of cancer patients on patient rights in the context of information and autonomy. Journal of Medical Ethics 2008; 34 (5): 384-388.
- Elger BS, Harding TW. Should cancer patients be informed about their diagnosis and prognosis? Future doctors and lawyers differ. Journal of Medical Ethics 2002; 28 (4): 258–265.
- Shahidi J. Not telling the truth: Circumstances leading to concealment of diagnosis and prognosis from cancer patients. European Journal of Cancer Care 2010; 19: 589-593
- Tuckett AG. Truth-telling in clinical practice and the arguments for and against: A review of the literature. Nursing Ethics 2004; 11 (5): 500-513.
- Zolkefli Y. The ethics of truth-telling in health-care settings. Malaysian Journal of Medical Sciences 2018; 25 (3): 135-139.
- Harbishettar V, Krishna K, Srinivasa P, et al. The enigma of doctor-patient relationship. Indian Journal of Psychiatry 2019; 61 (4): 776-781.
- Davies B. The right not to know and the obligation to know. Journal of medical ethics. 2020; 46 (5): 300–303.
- Peterson K. Informed refusal: A patient’s right? Nursing 2022; 52 (9): 15-20.