I foresee my few years of practice as a Physician Assistant being guided by aspects of clinical practice I find most important. A draft moral framework below explains these aspects.

Choosing the physician assistant profession did not come easily to me. I’ve always been fascinated by science but was hesitant about going to medical school and overwhelmed by feelings of inadequacy and indecisiveness. I planned to obtain a doctorate in organic chemistry and work in research and academics afterward. In my last year of studies, I realized that lab work wasn’t for me. I wasn’t feeling fulfilled and became increasingly disinterested. I decided to try out the medical field by becoming an EMT. Soon I discovered that I genuinely loved my job. I was driven by the rush, the knowledge, and most importantly the patients. After a few years of working I started feeling more confident in my skills and ability to take care of patients. But with confidence, came a feeling of limitation. I wanted to do more for my patients and have more of an impact. I decided to become a physician assistant to thoroughly care for the patients that ignited my passion for this profession.

The aspects of clinical practice that I anticipate will be most important to me are ensuring patients make informed decisions and instilling trust in adolescent patients. Ensuring informed decision making is something I find is lacking in many interactions between providers and patients. Providers often assume a patient will want the treatment the provider deems best and fail to tell patients about other options. Providers often fail to realize that what the provider chooses may not be what the patient values. In other instances, providers fail to inform patients of all side effects or consequences of treatments or procedures, leading to unanticipated effects and patients feeling helpless. Instilling trust in patients is also very important to me. Through my experiences, I’ve found that patients don’t tell providers everything if they don’t trust them. This issue is especially important when it comes to adolescents who are scared to speak about their concerns, fearing that their parents may find out intimate details or feeling embarrassed to discuss personal aspects of their lives.

Truth-telling in medical practice is the honest disclosure of facts and prognoses about a treatment or procedure. Truth-telling entails speaking about all details, positive and negative effects, and disclosing all knowledge available to patients (1). Autonomy can be defined as respecting a person by honoring their deliberated preferences (3) and can be broken down into four tenets, including free action, effective deliberation, authenticity, and moral reflection (2). Patients are entitled to make decisions and should be respected given that the patients have decisional capacity and are acting based on their true morals and authentic beliefs. Confidentiality can be defined as “practices and behaviors that serve to strengthen the trust and confidence between patients and their health-care providers” as stated by Kirk (4). Confidentiality entails privacy, secrecy, use of information disclosed by patients (4).

The principles of truth-telling and autonomy will most support the aspect of ensuring informed decision making. We expect our providers to tell us our diagnoses, the consequences of treatments, and educate us on what is happening in our bodies and minds. This principle sometimes gets misused, or rather, not used by providers. Providers may feel that they have conveyed sufficient information to the patient, but they failed to ask how much the patient wants to know or if the patient understands the information. Some providers may not mention all side-effects because they feel the patient may not be compliant due to feeling overwhelmed or worried. Providers may withhold information, deciding that breaking bad news or the truth about a diagnosis is not necessary or may provide emotional distress. Truth-telling is essential to practicing medicine. Providers are instilled with an honor that allows them to question and infiltrate the most private and intimate aspects of patients’ lives. With that honor comes the responsibility to tell the truth, given that the patient wants to hear it. Making assumptions about patients, how they will handle a situation, and what they can comprehend is in its own way negligent.

Autonomy is a principle that naturally follows truth-telling in ensuring informed decision making. Patients make decisions about their health depending on their values and preferences. Different aspects of treatments, medications and conditions will have varying effects on the patient. In order to give patients the power to make informed decisions, all information must be shared. A decision can only be made under the principle of autonomy if the patient is acting with free will, has deliberated about the situation and outcomes, is acting in a way authentic to their person, or has morally reflected on their decision. Withholding information about a diagnosis or treatment doesn’t allow the patient to effectively deliberate, engage moral reflection or be authentic. Withholding any aspect of the patients condition, care, or prognosis effectively impedes the patients autonomy.

Truth-telling allows the patient to fully understand their condition and make decisions based on information and personal values. If this information is not provided in its entirety, then the patients decisions cannot be deemed autonomous. I value truth and integrity and will make every effort to uphold those standards as I work. I want to disclose as much information as my patients need, educate them, and answer any questions they may have. I believe that if I can uphold these values and promote truth-telling and patient autonomy, my patients will be better equipped to make truly informed decisions.

Confidentiality is a principle central to instilling trust in adolescent patients to care better for them. Hearing other’s experiences, as well as reflecting on my own, I decided that I wanted to become a provider that patients can be open with and trust. Not having a trusted provider can be an obstacle to health for adolescents. Teenagers are prone to hiding their issues, feeling embarrassed about what’s happening to their bodies, and scared of how their parents may react to certain situations. I aim to instill trust in patients so that they never have to feel helpless. Simply stating that visits remains confidential between patient and provider, and patients’ parents will not be notified of every detail discussed, could lead to teenagers seeking help and disclosing important health issues. Ensuring patients that visits are confidential could lead to better patient care and outcomes. Confidentiality is the basis of a trusting relationship, that is then built around understanding, empathy, and care.

I foresee that ensuring informed decision making and instilling trust in patients will be two aspects that guide my first few years of work as a physician assistant. The draft moral framework above centers on these ideas and displays how the principles of truth-telling, autonomy, and confidentiality will support these aspects.

 

 

References

1. Tuckett, AG. (2004). Truthtelling in clinical practice and the arguments for and against: A review of the literature. Nursing Ethics, 11(5), 500-513.
2. Yeo, M et al. (2010). Autonomy [selections]. In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3^rd edition] Ontario: Broadview Press, pp. 91-97, 103-109.
3. Kirk, TW. (2014). Staying at home: Risk, accommodation, and ethics in hospice care. Journal of Hospice and Palliative Nursing, 16(4), 200-205.
4. Kirk, TW. (2015). Confidentiality. In N Cherny, M Fallon, S Kaasa, R Portenoy, & D Currow (eds.). Oxford Textbook of Palliative Medicine. (5^th) New York/London: Oxford University Press, pp. 279-284.