EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78712
April 2012 Chief medical editor's corner of the world Introducing our public board member— medical ethicist John Banja Dr. Chang: Tell us about your professional background and how you came to be an academician with a focus on medical ethics. Dr. Banja: I'm one of those peo- W hen the ASCRS Cataract Clini- cal Committee decided to or- ganize a program on ethical issues with premium IOLs at the 2010 ASCRS Annual Meeting, we enlisted a medical ethicist for our panel. As fellow participants, we all learned so much from listening to John Banja, Ph.D., that we in- vited him to return for our second ethics symposium in 2011 and again at this year's meeting. Dr. Banja is professor of rehabilitation medicine and medical ethi- cist at the Center for Ethics at Emory Uni- versity, Atlanta. His research interests include ethical dilemmas occurring in clinical and translational research. Dr. Banja is an associate editor of the Ameri- can Journal of Bioethics-Neuroscience, the leading scholarly journal in the field of neuroethics. His widely acclaimed book, Medical Errors and Medical Narcissism, discusses psychological and other barri- ers to the ethical disclosure of medical errors by physicians. Last year, the ASCRS Executive Committee decided to add a public trustee to our governing board. Dr. Banja was a unanimous choice, and he has added a much needed perspective to our board meetings. He's learned a lot about different IOLs in the process and can tell you the difference between a manual and femtosecond laser capsulotomy. I was among those fortunate enough to attend two ethics workshops that Dr. Banja led at the recent 2012 ASCRS Winter Update meeting in Cancun. They were thought- provoking and filled with practical pearls, and a summary of these sessions will ap- pear in the May issue of EyeWorld. We receive far too little education on medical ethics, so I have invited Dr. Banja to write a regular EyeWorld column on "Ethical issues in everyday ophthalmo- logic practice." Please write to him at jbanja@emory.edu to suggest a topic or question that you would like him to ad- dress. It is with great pleasure and grati- tude that I would like to introduce our first public ASCRS board member, Dr. Banja, in this month's column. David F. Chang, M.D., chief medical editor ple who stumbled into what eventu- ally became my life's work. I began my graduate studies in philosophy at Fordham University and com- pleted a doctorate degree in 1976. Back then, all I wanted to do was teach academic philosophy for the rest of my life, but I wasn't immedi- ately successful in landing a teach- ing job. I finally did get some part-time teaching opportunities at a small college in south central Penn- sylvania (St. Francis College, now St. Francis University), which had begun a physician's assistant pro- gram. They wanted someone to teach medical ethics, which was quite remarkable at a time when medical ethics was just getting un- derway. So I volunteered to do it— this was in 1980—and have been doing it ever since. Dr. Chang: As physicians, we believe that we hold ourselves to higher ethical standards than other fields and professions. Is there any research that confirms this? Is this changing for the better or worse? Dr. Banja: I'm not aware of any studies that look at how rigorously or how scrupulously physicians hold themselves to ethical behavior in comparison to other professions. But I can't imagine that clergymen, or veterinarians, or ethics professors believe that physicians hold them- selves to higher standards than they (although physicians might be a lot more compulsive). What the re- search does show, however, is that nearly every professional thinks that he or she is ethical, regardless of the facts. I'm afraid this even extends to organized crime. Even gangsters dis- miss the idea that they are immoral, rationalizing that they do what they do because "it's business" or that we all break the law. I'm contemplating a future column, incidentally, titled "We're all ethical, aren't we?" I think the more interesting spin on your question is, "Regardless of whether physicians hold themselves to higher ethical standards than other professionals, when the chips are down, do they act more ethi- cally?" Now don't get mad at me, they do. Nevertheless, I certainly don't think there's been a decline in ethical behavior among physicians, no matter how disillusioned or frus- trated with the system some have become. Dr. Chang: You recently held two workshops on ethics with oph- thalmologists attending the ASCRS Winter Update. What were your im- pressions of these sessions? Dr. Banja: We talked about John Banja, Ph.D. but I'd say the answer is probably no. Taking care of people who are sick or disabled is incredibly laud- able—perhaps the most wonderful, not to mention valuable, thing one human being can do for another. But does it make physicians more re- sistant to the ethical temptations of everyday life? Does graduating med- ical school, then a residency, and then establishing a practice enable one to act more ethically? I'd say probably not. For example, Lisa Iezzoni and her colleagues surveyed over 1,800 physicians nationwide in 2009 on their openness and honesty with patients (Health Affairs 2012; 31(2):383-391). Twenty percent of her respondents admitted that they did not fully disclose a mistake to a patient for fear of a lawsuit during the past year, while about a third said that they did not entirely agree with the practice of disclosing signif- icant medical errors to affected pa- tients. Only 45% claimed they never described a patient's prognosis more positively than warranted, and about 35% only somewhat agreed or downright disagreed with the prac- tice of disclosing financial relation- ships with drug or device companies with patients. Now, I don't quote these data to criticize physicians' integrity. Rather, they simply speak to the fact that physicians are just as tempted as other professionals to bend ethical rules or practices, and sometimes managing challenging patients and discussing fees. I was very gratified at the attendance, but I frankly was- n't surprised that physicians were in- terested in these topics. It can be immensely difficult to be with a pa- tient who is hateful, enraged, threat- ening, or malicious. And we do a poor job in medical school and resi- dency training at helping physicians develop communication skills to deal with these challenging situa- tions. I tell everyone that you can't learn enough about handling such situations, and the learning can (and maybe should) last a lifetime. Dr. Chang: Thank you for agreeing to write a regular column for EyeWorld on "Ethical issues in everyday ophthalmologic practice." What kinds of issues will you be dis- cussing? Dr. Banja: I'll certainly be dis- cussing "uncomfortable" communi- cation issues. These will cover a wide variety of situations including sub- optimal outcomes, fees, errors, etc. I'm also very interested in ethically assessing new technologies—do their benefits, for example, substan- tially outweigh their costs or incon- veniences? Also, I'm looking forward to learning more about fairness in reimbursing physicians. In order to answer that, you have to look at the payment criteria that have been set up because, presumably, they em- body fairness. I continue to suspect that some physicians are paid too much and others not nearly enough. If so, that needs to be remedied. I also plan to invite readers to submit questions of their own and occasionally invite a guest colum- nist. I'll be concentrating on practical ethical information for ophthalmologists, though, not on abstract, technical, soporific philoso- phy. EW EWOphthalmology Business 59