Aggiornare il codice etico del medico?

Questa raccomandazione, inclusa nel supplemento degli Annali di Medicina Interna del 3 Gennaio u.s., ha richiamato l’attenzionde della comunità internazionale suscitando una reazione immediata – e non solo a causa del raramente sentito termine “parsimoniosa”. E’ stata vista come una dichiarazione definitiva di etica medica diretta ai 132.000 membri dell’organizzazione – tutti medici specialisti in medicina interna e nelle sue specialità affini, tra cui la cardiologia e l’oncologia, branche in cui spesso si effettuano procedure costose. Soprattutto, questa guida arriva in un momento in cui i costi sanitari sono al centro del dibattito politico nazionale.

Lois Snyder, direttore del Centro ACP per l’Etica e Professionalità, dice che l’invito a porre attenzione per esercitare la professione medica con efficienza non è una novità – è stata una parte del manuale di Etica Medica fin dalla sua prima edizione nel 1984 e la parola “parsimoniosa” è apparsa la prima volta nel IV edizione del manuale .
“Ma siamo lieti di ottenere l’attenzione della comunità internazionale ora”, ha aggiunto.

Allora perché tutto questo clamore? “Credo che l’atmosfera sia diversa questa volta” dice Snyder “le persone sono più consapevoli di questi problemi”.

Difatti, in questo momento, priorità e necessità si incontrano. Va affrontata la sfida della sostenibilità del Sistema Salute, proprio per garantire un equità dell’accesso alle cure da parte di tutti senza distinzione di età o condizioni sociali.

Liberamente tradotto dalla news di http://www.kaiserhealthnews.org/

12 GEN – Stefano Bottari, primario chirurgo a Roma, ha deciso di non operare un paziente in elezione (non urgente) che aveva denunciato un medico. A riferirlo è Amami, l’Associazione dei medici accusati ingiustamente di malpractice, secondo la quale “se la legge non ci metterà al riparo dai danni conseguenti alle denuncie infondate di malpractice, i medici, impauriti, si asterranno dall’operare cittadini non urgenti” e il caso di Bottari dimostra che i medici, “in questo clima da caccia alle streghe – alimentato da campagne pubblicitarie che incitano a citare i medici in giudizio – hanno iniziato a rifiutare gli interventi dei pazienti ‘a rischio-denuncia’”, afferma il presidente dell’Associazione, Maurizio Maggiorotti.

Secondo quanto riportato dalla nota dell’Amami, Bottari avrebbe raccontato che il paziente ha richiesto una visita per un intervento riparatore a seguito di un’operazione, a detta dello stesso, “riuscita male”. “Con un atteggiamento rivendicativo ha presentato il caso come esempio di malasanità. In questo contesto poco rassicurante, – ha affermato Bottari, secondo quanto riferisce la nota dell’Amami – non mi sono trovato nella condizione di serenità giusta per il compimento di un intervento chirurgico. Mi sentivo in tensione e in pericolo per l’eventualità di essere esposto anche io e la struttura nella quale opero a ritorsioni legali. La chirurgia – ha aggiunto Bottari – deve essere affrontata con la mente libera e con il giusto stato d’animo, e non con la paura di essere denunciati. E’ necessario un rapporto di totale fiducia tra medico e paziente perché lo stato di paura del chirurgo mette a rischio la buona riuscita dell’intervento. Diventa quindi un obbligo rifiutare l’operazione per proteggere il paziente”.

“I professionisti – commenta l’Amami – hanno sempre più paura di ricevere danni di immagine ed economici da una denuncia, anche se priva di fondamento, perché, con le attuali norme, determina la disdetta da parte dell’assicurazione. Ricaduta che potrebbe essere pesante sui medici, dal momento che il DPR 138 del 13 agosto 2011 rende obbligatoria la copertura assicurativa professionale e ciò li porterebbe ad essere dei fuorilegge”.

da QuotidianoSanità

Medical Leadership Competency Framework

The Medical Leadership Competency Framework (MLCF) has been jointly developed by The Academy of Medical Royal Colleges and the NHS Institute for Innovation and Improvement in conjunction with a wide range of stakeholders.

The Medical Leadership Competency Framework describes the leadership competences doctors need in order to become more actively involved in the planning, delivery and transformation of health services.

The MLCF is a pivotal tool which can be used to:

• Help design of training curricula and development programmes
• Highlight individual strengths and development areas through self assessment and structured feedback from colleagues
• Help with personal development planning and career progression.

The Medical Leadership Competency Framework is built on the concept of shared leadership where leadership is not restricted to those who hold designated leadership roles, and where there is a shared sense of responsibility for the success of the organisation and its services. Acts of leadership can come from anyone in the organisation, as appropriate at different times, and are focused on the achievement of the group rather than of an individual. Therefore shared leadership actively supports effective teamwork.

We very much hope that the Medical Leadership Competency Framework will contribute to the vision articulated recently:
“The doctor’s frequent role as head of the healthcare team and commander of considerable clinical resource requires that greater attention is paid to management and leadership skills regardless of specialism. An acknowledgement of the leadership role of medicine is increasingly evident. Role acknowledgement and aspiration to enhanced roles be they in subspecialty practice, management and leadership, education or research are likely to facilitate greater clinical engagement”
Aspiring to Excellence, Prof John Tooke, 2008

“Greater freedom, enhanced accountability and empowering staff are necessary but not sufficient in the pursuit of high quality care. Making change actually happen takes leadership. It is central to our expectations of the healthcare professionals of tomorrow.”
Next Stage Review: High Quality Care for All, July 2008

“It is not enough for a clinician to act as a practitioner in their own discipline. They must act as partners to their colleagues, accepting shared accountability for the service provided to their patients. They are also expected to offer leadership and to work with others to change systems when it is necessary for the benefit of patients.”
Tomorrow’s Doctors, 2009

more

Steve Thomason, MD

Fam Pract Manag.�1999�Jul-Aug;6(7):37-40.

In medical school, we learned the language of medicine with its Greek and Latin roots, its abbreviations and its acronyms, and we communicate effectively with other physicians when we use it. But that training, for most of us, didn’t include the language of health care, which has evolved quickly in recent years into a distinct lexicon of terms like HMO, point of service, return on investment and integrated delivery system. Add the knowledge requirements for human-resources management, financial decision making and regulatory compliance, and you find that many physicians are woefully deficient in the skills necessary to provide leadership in health care. So a dichotomy exists in our system: Physicians generally have one skill set for delivering clinical care, and managers need a separate skill set for administering the business of health care. Physicians who can bridge the gap — through natural talent or additional training — have a real opportunity to lead health care organizations as physician executives, and the rewards are significant, both in personal professional satisfaction and in organizational success.

Why physician executives?

“Administrative medicine” is a good fit for those who have insight into the doctor-patient relationship (the core product of health care) and an ability to think about operations globally. Before health care reform gained such momentum in this country, we had a triad of health care leadership: Doctors primarily cared for patients, business managers ran doctors’ offices and business executives ran hospitals and insurance companies. This delineation contributed to the creation of a silo effect in health care, with each party focusing on its own division of the system, often at the expense of efficiencies in other divisions. This has led to many conflicts of interest in our system and a great deal of mistrust and misunderstanding; in fact, much of the purpose of health care reform has been to realign the interests of health care providers, payers and purchasers so that they work toward mutually beneficial processes of care delivery. But market-based reform also has shown the need to “imprint medical expertise on business dynamics” in health care, and physicians with strong leadership skills are in a position to do just that.1

At the same time, the concept of leadership has shifted dramatically. Leaders are no longer taskmasters; they are facilitators of empowerment, motivation and maximum performance by all individuals in the organization, whether that be a clinic, a hospital, a health plan or an integrated delivery system.2

Portrait of a physician executive

What does a physician leader in one of these organizations do all day? The principal duties vary widely depending on the position and type of organization. A survey by the Physician Executive Management Center found that the most common duties of physician executives were serving as a liaison between physicians and the administration, overseeing quality management programs, credentialing providers, supervising physicians and strategic planning.3

To be effective in tasks like these, what skills should a physician executive possess? Respondents to the Physician Executive Management Center survey identified these skills most frequently:3

• Effective communication in writing, interpersonal discussions and formal presentations;
• The ability to persuade, motivate and influence others;
• The ability to lead strategic planning;
• Computer skills;
• Skills in financial administration and personnel management (areas in which physicians have traditionally relied on others for expertise).

The qualities of physician leaders may be described in various ways for various purposes. Here’s another approach — a somewhat wide-ranging but still useful list of the abilities and characteristics that a physician executive needs for success:

• A concept of illness as a whole,
• An ability to build his or her knowledge,
• A vision for the future,
• A strategy for realizing that vision,
• An ability to create value (i.e., optimize the cost-quality relationship),
• A generalist mind-set,
• An ability to master change and lead the organization through it,
• An ability to shape the market by having a keen sense about customers and competitors.4

How might you go about developing the qualities that a physician leader needs? Opportunities for education and training in executive skills abound (see “Educational resources for physician executives”).

In a nutshell, physicians who like their daily routines to remain fairly constant, are comfortable with the status quo and are uncomfortable with change (especially when change appears to be forced on them) typically will not enjoy the role of physician executive. Conversely, those who are easily bored with routine, often propose radical change and are comfortable when someone else institutes new processes that affect their work (especially if the new processes make sense to them) will generally find satisfaction in many of a physician executive’s duties.

In many ways, physicians — particularly primary care physicians who, as generalists, are trained to treat the whole person — are uniquely suited for leadership positions. In medicine, all of us have learned to deal with ambiguity. We face crisis and tension by making decisions that affect people’s lives. We’ve learned through history-taking to listen to people, and many of us are adept at interpreting nonverbal cues. Because of our training, we’re experienced in situations that require endurance, perseverance, self-motivation and self-confidence. And we still enjoy a certain measure of credibility, in health care and in society, by virtue of our status as physicians.

But is it a portrait of me?

There are differences between clinical practice and administrative medicine that pose potential problems. Changing your central focus from patients to the organization requires a number of psychological adjustments. The instant gratification of seeing a disease resolve or receiving a patient’s sincere thanks is not part of management. Making people unhappy becomes part of your job; whatever decision a manager makes, someone will be dissatisfied. In becoming a physician executive, your role changes from one of independence to one of dependence, from autonomy to the need to delegate in order to get the work done. You must learn the intricacies of organizational dynamics so you can avoid the traps of working in a large system. And you must learn the language of finance.

The successful physician executive discovers that his or her approach to work must change in two other important ways. First, an effective leader persuades rather than controls; and making this change is often difficult. Second, when you move from a comfortable relationship with colleagues to a position of authority over them, those relationships change forever, no matter how hard you try to maintain them. Wariness, frustration and often contempt become factors in your relationships with other physicians.5

If, given these caveats, you’re still interested in moving into medical administration, ask yourself the “Questions to consider before making the switch.”

To practice or not to practice?

Ten years ago, half the physicians in senior-management positions continued to have part-time clinical duties. Today, only 13 percent of that group practice medicine at all.3 This significant decrease is thought to be related to the expanded roles of physician executives as the penetration of managed care has increased.

For physicians, probably more than for members of any other profession except perhaps clergy, our identities as individuals are tied to the responsibilities and privileges of our work. How we’re viewed by the community at large contributes greatly to this. We may be serving as parents, friends, neighbors, civic activists or board members, but our communities still regard us as physicians first.

Our self-identity and the community’s eyes are focused on our role as healers, and for many physicians, serving in administration without carving out time to practice medicine leaves a void. Many hang up the stethoscope only to discover that they miss doctor-patient encounters — the ability to help others directly and see the difference they make in individual patients’ lives. In addition, it takes very little time out of clinical practice for us to lose state-of-the art clinical skills and knowledge, especially considering the speed of advances in diagnostic and therapeutic technologies. And don’t forget that your credibility with fellow physicians and the community may rapidly deteriorate if you don’t maintain your role as a clinician.

It’s worth a look

Opportunities for physicians to enter the administrative side of health care abound, as evidenced by the number of ads for physician-executive positions in professional journals and the increasing number of seminars being offered to train physician leaders. Health care organizations are realizing that the blend of skills and knowledge that physicians bring to management can spur great organizational change and improvement, and many physicians are finding these new leadership roles exciting, challenging and rewarding. Administrative medicine is clearly a frontier that family physicians would do well to explore — if they’re willing to become bilingual in the lexicons of medicine and health care management.

Here are some suggestions for your first post.

1. You can find new ideas for what to blog about by reading the Daily Post.
2. Add PressThis to your browser. It creates a new blog post for you about any interesting  page you read on the web.
3. Make some changes to this page, and then hit preview on the right. You can always preview any post or edit it before you share it to the world.