A NEED ASSESSMENT OF ETHICS COURSE FOR PRIMARY CARE PHYSICIAN: PHYSICIANS' PERSPECTIVE IN YOGYAKARTA PROVINCE, INDONESIA

https://doi.org/10.22146/jpki.84991

Hikmawati Nurrokhmanti,(1*), Adi Heru(2), Hari Kusnanto Joseph(3)

(1) Department of Medical Education, Faculty of Medicine, Universitas Gadjah Mada
(2) Department of Family Medicine and Community Health, Faculty of Medicine - Public Health, Nutrition and Nursing, Gadjah Mada University
(3) Department of Family Medicine and Community Health, Faculty of Medicine - Public Health, Nutrition and Nursing, Gadjah Mada University
(*) Corresponding Author

Abstract


Background: Primary care physicians, as first-line doctors, deal with ethical cases that challenge them to make the best patient decisions. Helping primary care physicians to be more aware of ethical cases and the process of case decision-making will improve all stakeholder's needs. Physician standard opinion on the best decision for their patient will be the baseline of suited training for them.

Methods: We conducted a mixed-method study to understand GP decisions regarding certain ethical cases. In the quantitative phase, we used and presented several standardized ethical cases with several "decisive" options followed by reason. For qualitative, in-depth guided interview was done with several physicians. The data was analyzed by close system coding.

Results: We gained 36 responses from several physicians with 12 in-depth interviews. In the quantitative, we found that two questions related to communicating the mistake and the rural problem had the worst response, showed by highly unfavourable answers. The interview found that most physicians find it hard to decide on ethical cases, acknowledge religion as one aspect for making the decision, and expect a clear guideline that will help them make a firm decision regarding "difficult" dilemma cases.

Conclusion: To avoid bad decision-making in ethical-related cases, the physician must take another training since low awareness of ethical cases will lead to unfavourable decisions regarding some dilemmas. Considering the methods and number of subjects in this research, the training should apply a specific strategy to all physicians.


Keywords


ethical cases; decision making; physician; primary care

Full Text:

PDF


References

  1. Slowther A. Ethics case consultation in primary care: Contextual challenges for clinical ethicists. Cambridge Q Healthc Ethics. 2009;18(4):397–405.
  2. Robillard HM, High DM, Sebastian JG, Pisaneschi JI, Perritt LJ, Mahler DM. Ethical issues in primary health care: A survey of practitioners’ perceptions. J Community Health. 1989;14(1):9–17.
  3. Dayringer R, Paiva REA, Davidson GW. Ethical decision making by family physicians. J Fam Pract 1983; 17: 267-272.
  4. Gágyor I, Heßling A, Heim S, Frewer A, Nauck F, Himmel W. Ethical challenges in primary care: A focus group study with general practitioners, nurses and informal caregivers. Fam Pract. 2018;36(2):225–30.
  5. Lawson AD. What is medical ethics? Trends Anaesth Crit Care [Internet]. 2011;1(1):3–6. Available from: http://dx.doi.org/10.1016/j.cacc.2010.02.009
  6. Tunzi M, Ventres W. Family medicine ethics: An integrative approach. Fam Med. 2018;50(8):21–6.
  7. Page K. The four principles: Can they be measured and do they predict ethical decision making? BMC Med Ethics. 2012;13(1):1–8.
  8. DeMarco JP. Principlism and moral dilemmas: A new principle. J Med Ethics. 2005;31(2):101–5.
  9. Al-Bar MA, Chamsi-Pasa H. Virtue ethics and moral character related to medical profession dalam Contemporary bioethics. Islamic perspective, 2015; pp 75-84, Springer, Cham.
  10. Wong W, Eiser AR, Mrtek RG, Heckerling PS. By-person factor analysis in clinical ethical decision making: Q methodology in end-of-life care decisions. Am J Bioeth. 2004;4(3).
  11. Souza P, Pastura VC, Gerardin M, Land P. The perspective of Virtue Ethics regarding the process of medical decision-making. Rev bioét [Internet]. 2016;24(2):243–52. Available from: http://dx.doi.org/10.1590/1983-80422016242124
  12. Nandi PL. Ethical aspects of cli nical practice. Arch Surg. 2000;135(1):22–5.
  13. Forester-Miller H, Davis TE. Practitioner’s Guide to Ethical Decision Making. Am Couns Assoc - Cent Couns Pract Policy, Res [Internet]. 2016;1–6. Available from: http://www.counseling.org/docs/default-source/ethics/practioner’s-guide-to-ethical-decision-making.pdf?sfvrsn=0
  14. Roshanzadeh M, Vanaki Z, Sadooghiasl A. Sensitivity in ethical decision-making: The experiences of nurse managers. Nurs Ethics. 2020;27(5):1174–86.
  15. Arslan FT, Calpbinici P. Moral sensitivity, ethical experiences and related factors of pediatric nurses: A cross-sectional, correlational study. Acta Bioeth. 2018;24(1):9–18.
  16. Kirilmaz H, Akbolat M, Kahraman G. A Research about the Ethical Sensitivity of Healthcare Professionals. Int J Heal Sci. 2015;3(3).
  17. Alyousefi N, Alibrahim A, Taleb H, Alotaibi L, Alrahmah L, Aldubaib N, et al. The predictors of moral sensitivity among physicians. Int J Gen Med. 2021;14:6815–23.
  18. Wong W, Eiser AR, Mrtek RG, Heckerling PS. By-person factor analysis in clinical ethical decision making: Q methodology in end-of-life care decisions. Am J Bioeth. 2004;4(3).
  19. Gordon, G. H. (2005). Disclosing error to a patient: Physician-to-patient communication. Virtual Mentor, 7(8), 537–540. https://doi.org/10.1001/virtualmentor.2005.7.1.ccas1-0508
  20. Cardasis, J., & Brush, D. R. (2011). Responding to patient requests for nonindicated care. Virtual Mentor, 13(1), 16–20. https://doi.org/10.1001/virtualmentor.2011.13.1.ccas3-1101
  21. List, J. M. (2011). Virtual Mentor - stas1-1209.pdf. 13(7), 494–498. http://journalofethics.ama-assn.org/2012/09/pdf/stas1-1209.pdf
  22. Case, E. (1905). American Medical Association Journal. California State Journal of Medicine, 3(6), 195–196. http://www.ncbi.nlm.nih.gov/pubmed/18733507%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC1650661
  23. Jones VV. Herbal supplements as placebos. Virtual Mentor. 2011 Jun 1;13(6):354-8. doi: 10.1001/virtualmentor.2011.13.6.ccas3-1106. PMID: 23131401.



DOI: https://doi.org/10.22146/jpki.84991

Article Metrics

Abstract views : 430 | views : 552

Refbacks

  • There are currently no refbacks.


Copyright (c) 2023 Hikmawati Nurrokhmanti,

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Jurnal Pendidikan Kedokteran Indonesia (The Indonesian Journal of Medical Education) indexed by:


JPKI Stats