Chapter 4: Professionalism, Elitism and Health Care

Section 1. Case Presentations

We return to examine the three cases that appeared at the very beginning of this text.  In this chapter there will be a presentation of a perspective or orientation from which the three cases may be examined and remarkably different responses will be elicited that depend on the alternative orientations or , in the terms of this chapter, the models that may be operative in these situations and many others like them in medicine and health care.

1. Whistle Blowing

  • Dr. D: surgeon
  • Dr. A: anesthesiologist
  • Nurse N: scrub Nurse in OR

Dr. D is about to perform a surgery-an appendectomy. It is 3pm Dr. A and nurse N both observes Dr. D with slurred speech and detects alcohol on his breath. Dr. D prepares for the surgery. The patient is anesthetized. Dr. D. is handed the scalpel and drops it then fumbles to pick it up again. Dr. A asks, "Are you alright?" Dr. D answers, "Of courses I am!"  "Let's get this done."

Dr. A:  "Doctor, perhaps we could postpone this?"

Dr. D: " No, I'm perfectly all right."

Nurse N: "I'm not so sure."

D: " Who are you to tell me what to do?"

Should A and N continue to assist D in the surgical procedure? Should they physically restrain D? Should this event be reported? If so, by whom and to whom? What should be done then?

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2. Truth Telling

80 year old female B has cancer of the uterus-metastasized- and through the pancreas and liver

She asks her physician A "Just what are my chances?"

The doctor wonders what exactly to tell her: should the physician report the exact findings of the various tests and their meaning in terms of the prognosis in the clearest manner possible or should the physician present a less negative report in a compassionate manner even though the report will not be as accurate or as truthful as it otherwise might be?

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3. Letting Die

A 45 year old female with ALS. Diagnosed three years earlier she has endured continual loss of control over her muscles and deteriorated considerably. She is immobilized and has experienced several respiratory failures and now asks her doctor to leave her alone. The next time she experiences respiratory arrest she wishes to be left alone to die. Should the doctor grant her request? Follow her instructions?

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In this chapter the manner of response to these questions will be revealed to be formed by, influenced by and indicate one or more of the various models that are operative for the participants in medicine and health care as providers and practitioners.

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Copyright Philip A. Pecorino 2002. All Rights reserved.

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