Microethics in Pediatric Ophthalmology
Amy Huang, BA; Megan E. Collins, MD, MPH
Johns Hopkins University School of Medicine, Wilmer Eye Institute
Baltimore, Maryland, USA
Introduction: Microethics, also known as everyday ethics, recognizes that there are subtle ethical issues embedded in routine interactions with patients . While formal ethics education focuses on principles of autonomy, justice, beneficence and non-maleficence, little guidance is provided to physicians or trainees about ethical dilemmas that arise during everyday clinical encounters . No prior work has examined microethics in ophthalmology.
Methods: A retrospective chart review of 96 patients seen by one pediatric ophthalmology provider at an academic medical center was performed. Qualitative methodology techniques were used to identify ethics themes in clinical encounters by modifying constructs previously described by Truog and Moon [1,3].
Results: Encounters from 96 patients were analyzed (77 pediatric and 19 adult strabismus patients). The majority of patients (n=68) had strabismus and/or amblyopia; 12 were within the 6-month perioperative period.
The most common microethics themes identified were:
• Shared decision-making with parents and other caregivers
• Managing patient expectations regarding goals of care
• Overcoming language and cultural barriers in communication
• Professionalism and disclosing medical errors
• Time management and competing patient demands
• Negotiating with non-compliant patients
• Clinical biases in decision-making
• Impact of electronic medical record on doctor-patient relationship
Discussion: Co-morbidities, language barriers and history of multiple providers were additional challenges in building trust and developing a therapeutic alliance with patients.
Conclusion: Microethics issues are commonplace in pediatric ophthalmology. Creating a framework to identify issues will help increase physician awareness and initiate conversations about ways to approach ethics in everyday practice. It can also be a useful strategy to incorporate ethics into the teaching of trainees.
References: 1. Truog, R. D., Brown, S. D., Browning, D., Hundert, E. M., Rider, E. A., Bell, S. K. and Meyer, E. C. (2015), Microethics: The Ethics of Everyday Clinical Practice. Hastings Center Report, 45: 11-17. doi:10.1002/hast.413
2. Carrese JA, McDonald EL, Moon M, et al. Everyday ethics in internal medicine resident clinic: an opportunity to teach. Medical Education. 2011;45(7):712-721. doi:10.1111/j.1365-2923.2011.03931.x.
3. Moon M, Taylor HA, McDonald EL, Hughes MT, Carrese JA. Everyday Ethics Issues in the Outpatient Clinical Practice of Pediatric Residents. Arch Pediatr Adolesc Med. 2009;163(9):838-843. doi:10.1001/archpediatrics.2009.139