A. G. Antunez2,3, L. Dossett1,2 1Michigan Medicine,Department Of Surgery,Ann Arbor, MI, USA 2Institute For Health Policy And Innovation,Ann Arbor, MI, USA 3University Of Michigan Medical School,Ann Arbor, MI, USA
Introduction:
Surgical specialists are uniquely positioned to identify errors that have occurred during a patient’s diagnosis or treatment prior to referral. Specialists describe significant discomfort and physician and profession-centered barriers to giving feedback to the providers responsible for these errors. This analysis uses an ethical framework grounded in professional values to assess specialists’ obligations to communicate with referring physicians regarding pre-referral errors.
Methods:
We systematically explored the relevant principles from modern professional ethics literature, and applied them to cases where specialists discover the error of a referring physician. We explored these principles in the context of case studies described in previous qualitative work.
Results:
The traditional, four-principle medical ethics framework (autonomy, beneficence, non-maleficence, and justice) has been adapted to modern practice in recent writings on professional ethics in medicine. Modern physicians should be accountable to their colleagues, responsible for their patients’ health, continuously improving their practice, allocating care fairly, and utilizing resources appropriately. Using the principles evoked in these modern codes (Figure 1), we demonstrate that providing feedback about pre-referral errors is an ethical behavior and that in order to fully uphold these values, specialist physicians have a duty to provide feedback to referring providers. The process of giving feedback fulfills a physician’s duty in each of these ethical domains, while failing to do so can harm patients, providers, and the profession.
Conclusion:
Physicians have an ethical obligation to provide feedback after discovering pre-referral errors. This duty can be derived from the multi-faceted code of modern professional medical ethics. With potential negative repercussions for both parties, specialists may find it difficult to fulfill this obligation. Systems-based professionalism may offer a method of making feedback more commonplace, by providing regular opportunities for referring providers and specialists to dialogue. This may alleviate the discomfort or overcome the physician and profession-centered barriers that prevent specialists from acting on their principled inclinations.
