In medicine, ethical issues are often seen as clear-cut choices between right and wrong. However, in reality, they are frequently far more complex, especially when multiple legitimate solutions exist for the same problem. Joseph L. Badaracco, a distinguished professor at Harvard Business School, introduced the concept of “Right vs. Right” decisions—situations where conflicting values or duties create ethical dilemmas without an obvious answer. These “Right vs. Right” dilemmas are a common occurrence in medicine, challenging both physicians and patients nearly every day.
Consider the following scenarios:
An obstetrician is treating a pregnant patient whose life is at serious risk due to her pregnancy, but the patient refuses to consent to a termination that could save her life.
An orthopedic surgeon recommends amputating a gangrenous limb to prevent life-threatening sepsis, yet the patient declines the procedure.
An oncologist advises a patient with an early-stage cancer to begin chemotherapy to prevent further spread, but the patient chooses to pursue an unproven alternative treatment instead.
In each case, both the patient’s autonomy and the physician’s duty to preserve life clash, leading to ethical dilemmas where both choices can be viewed as “right” from different perspectives. So, what should physicians do when confronted with such dilemmas?
The Digital Age: Adding Complexity to Ethical Decision-Making
Today, the digital landscape has only amplified the complexity of medical ethics. With unprecedented access to information, alternative healers, and aggressive marketing—sometimes promoting unproven or even harmful treatments—ethical principles can feel more prescriptive than practical.
The issue isn’t that healthcare professionals don’t understand ethical frameworks. The real challenge lies in applying these principles in a world that is increasingly dynamic, unpredictable, and digital. The real question isn’t just what the ethical principles are, but how and why they should be applied in the context of evolving patient behaviors, informed (or misinformed) by online sources.
In this discussion, we’ll explore how physicians can navigate “Right vs. Right” decisions in their daily practice.
Here are the guiding questions for our chat:
T1. Have you encountered a “Right vs. Right” ethical dilemma in your practice? How did you resolve it?
T2. What was your primary challenge in resolving such a dilemma?
T3. In today’s digital world, what ethical framework would you recommend for resolving “Right vs. Right” dilemmas?
Don’t forget to use #HealthXPH in all your tweets. See you this Saturday, October 5, 2024, at 9 PM (Manila time)!
Ah yes, sports and fitness… again?! I know, it’s the last thing many of us healthcare professionals want to talk about. We’re busy saving lives, managing stress, and battling the daily grind. But this topic just too important to ignore. So, let’s dive in.
Seriously though, how many of us, despite knowing the undeniable benefits, consistently engage in sports or fitness activities? The key word here is consistent. Yes, we tell our patients to “exercise regularly” but, let’s be honest, how many of us actually practice what we preach? Personally, I’ve struggled with this myself, and I know I’m not alone. Even athletes—those fitness gods—have their ups and downs. But unlike them, sports and fitness are not our profession.
For us mortals—busy, overworked healthcare professionals—finding time and energy for fitness feels like climbing a mountain. But here’s the kicker: we, of all people, should be leading by example. Yet, many of us are trapped in a cycle of inconsistency, letting our mental and physical health slip.
The Moment of Realization
I had my wake-up call just six months ago when I caught a glimpse of myself in the mirror. There I was, staring at a pot-bellied version of myself, wondering how long before my clothes would burst at the seams. The weighing scale wasn’t kind either. Then, I noticed a colleague stacking up maintenance meds like they were vitamins—some even taking five different pills a day. It made me wonder: am I the odd one out for not being on medication yet?
To add salt to the wound, my patient went to someone else for weight loss advice after consulting me. Ouch. That was the final push I needed to realize that something had to change.
Let’s Skip the Basics and Get Real
We already know the benefits of physical activity—let’s not waste time repeating them. The real conversation we need to have is about the barriers. Why aren’t we, as healthcare professionals, engaging in consistent sports and fitness activities? What’s holding us back, and more importantly, how can we overcome these barriers?
This Saturday at 9PM Manila time, during our #HealthXPH Twitter/X chat, we’ll tackle these questions head-on.
T1: What are the common barriers for healthcare professionals to consistently engage in sports and fitness activities?
T2: What is your compelling motivation to consistently engage in sports and fitness activities? And if you’re not into fitness yet, what could motivate you?
T3: What tips or strategies have helped you stay consistent with sports and fitness?
I won’t give away my thoughts just yet. I want to hear from all of you—your experiences, your struggles, and your solutions. Afterward, I’ll follow up with a post summing up the best advice and tips from our collective wisdom.
In the meantime, start warming up! Get those fingers ready to tweet and, more importantly, stretch those hands and bodies before and after our hour-long chat. See you Saturday at #HealthXPH, and let’s move towards better health together!
P.S. If you’re already feeling inspired (or guilty, like I was), why not take a few minutes to schedule that long-overdue workout? You deserve it—your patients, your family, and most importantly, your future self will thank you.
Revisiting the ethical social media principles then and applying it now.
The recent social media controversy that irked many in the Philippine medical community is this- a student nurse posting a video of a healthcare worker doing a medical procedure, on tiktok. While this, arguably constitute a breach of privacy and confidentiality and the ethical ramifications are quite disturbing, I wonder why the student nurse failed to grasps an established social media and medical etiquette? Did we somehow missed something when crafted the social media guidelines before for future generations? Maybe it’s time to revisit this.
The #Healthxph was founded as a community of healthcare social media practitioners, laying down the foundations of the ethical use of social media to achieve common good in healthcare. We even have our signed manifesto accepted by the different medical associations in the country. I and many of #healthxph team talked about ethical and good use of social media in healthcare and even came up with actual conferences about it. That was ten years ago. Now, we are seeing a resurgence in privacy and confidentiality breaches in healthcare with the use of social media. Again, did we miss something here? Implementation? Commitments? This will be the topic of our chat today.
T1. Do you see a resurgence in healthcare privacy and confidentiality breaches with the use of social media?
T2. Is the healthcare community effective in preventing privacy and confidentiality breaches on social media?
T3. Recommend three ways of preventing preventing privacy and confidentiality breaches on social media.
I’d like to share my previous talk on How should nurses act on social media platforms. This was part of my speech during the Annual Convention of the Philippine Nurses Association in Davao City. I knew this student is not yet a full fledged nurse, but it may be good to start early. What do you think?
Join #healthXPh chat on this topic this Saturday Aug 10 9PM Manila time. See you all!
[su_dropcap]A[/su_dropcap]s healthcare professionals, we dedicate our lives to the health and well-being of others. Yet, amidst demanding schedules, long hours at work, and constant emotional and physical toll, we still think our body will handle itself, without us “helping” or investing time and effort on our overall well being.
[su_box title=”Stories from the Clinics”] A patient sought consult for a low back pain and tingling sensation down his legs. He is overweight and his random blood sugar was elevated on testing. Both his parents were diabetic. I asked if he consulted an internist or endocrinologist. “Not yet, but I will” he said. After doing a physical examination, additional diagnostics, preliminary diagnosis and strategy for managing his concerns, he asked me this question “what is your physical activity and how do you avoid obesity? This patient obviously noticed my “not so healthy physique” but courteously waited for my advice. So as an orthopedic surgeon, I advised him what I know about the (theoretical) benefits of physical activity and proper nutrition to his overall well being. Then he followed up with – “How”? I paused for a moment and replied, ” I try fitting all that into my busy schedule. My answer confused him even more. I doubt he’d follow my concoction of advice, seeing that I, a physician, was obviously out of shape. [/su_box]
This clinical encounter flashed backed months ago, when I saw my physique on a mirror. I am out of shape! Last year alone, I saw two colleagues my age succumbed to lifestyle disease-related complications. Another one took his own life. I got so scared I started researching physical and nutritional health, again. I did the same research, activity and dieting, several times in the past. I even went on organic farming to support these effort but well, failed. So not this time I promised. I also delve into specifics of incorporating such healthy physical and nutritional lifestyle into a busy physician life. Is it even possible?
Share Your Insights
For this conversation, I wanted to learn how healthcare professionals maintain well-being while delivering the best care possible. I want to reach out and gain insights from colleagues’ experiences. Your experiences and strategies can provide invaluable guidance and support to fellow physicians navigating similar challenges. Here are three main questions I’d love for you to answer:
T1. How Do You Manage Stress and Prevent Burnout?
Burnout, characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment, is a prevalent issue among physicians. There’s no published local data yet, but according to a study published in the Journal of the American Medical Association (JAMA), more than half of U.S. physicians experience substantial symptoms of burnout (Shanafelt et al., 2015). How do you manage stress and prevent burnout in such a high-pressure environment? Are there specific strategies, routines, or practices you follow?
T2. How Do You Prioritize Your Physical Health?
Given the irregular hours and intense workload, maintaining physical health can be challenging for healthcare professionals. Regular exercise, a balanced diet, and sufficient sleep are fundamental to overall well-being but are often compromised. An 2018 FNRI study showed 37.2 % of Filipinos adults are obese. Since 1993 to 2018, fasting blood glucose is increasingly elevated in adults. Approximately 40% of Filipino adults are also physically inactive. While these figures do not single out healthcare professionals, it doesn’t exempt us either. According to the American Medical Association, a significant number of physicians report insufficient sleep, which can impair cognitive function and overall health (American Medical Association, 2017). How do you ensure you get enough sleep, exercise regularly, and maintain a healthy diet? What tips and tricks do you have for balancing these aspects amidst your busy schedule?
T3. How Do You Sustain Mental and Emotional Well-being?
The emotional demands of being a physician are immense. I witness doctors quit training because “they couldn’t handle the pressure”. I talked to a colleague shifting into an outpatient only practice because in patients took much of his night time sleeps. Dealing with patients’ suffering, making critical decisions, and managing complex relationships can take a toll on your mental health. The National Academy of Medicine highlights that mental health issues among physicians are often underreported and undertreated (National Academy of Medicine, 2019). How do you take care of your mental and emotional well-being? Are there support systems, hobbies, or mindfulness practices that you find particularly helpful?
[su_box title=”Key Takeaways”]Healthcare professionals should balance their physical and mental well being while taking care of their patients and their families. The best way to do this is to invest time and effort on physical and mental activities, incorporating these into our daily life/work routines.[/su_box]
“If you don’t make time for exercise, you’ll probably have to make time for illness.”
Will that patient follow my advice when he sees my physique now? Will my improve physical and mental well being impact my work as a physician? Please share your insights in the chat with the guide questions above . Kindly append your answers with #healthxph hashtag. Your insights should help foster a community of well-being and resilience among colleagues.
Shanafelt, T. D., Hasan, O., Dyrbye, L. N., et al. (2015). Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. JAMA, 314(22), 2334-2343. doi:10.1001/jama.2015.13971
American Medical Association. (2017). Addressing physician burnout: The way forward. Retrieved from https://www.ama-assn.org
I’ve been in healthcare for almost 30 years, starting out as a medical student, a general practitioner, a resident physician, orthopedic surgeon, then a training faculty progressing into the various clinical, academic, administrative roles I have taken past or present. In all of these roles, there’s no more challenging issue I’ve faced than conflict resolution, be it with a junior or senior colleague, an administrative boss, policy makers, regulators, and even the system itself. What’s interesting is that our habit and practice of resolving conflicts ebbs and flows throughout one’s career as a healthcare professional. Even now, I’m still learning and discovering new ways of resolving conflicts.
The current scandal rocking the entire Philippine healthcare landscape- already beaten to bones by previous scandals and pandemic, weaves a web of conflicting factors and stakeholders interests, one shrug in dismay, if there’s a resolution in sight. Don’t get me wrong, I do understand every stakeholder in this conflict have good if not great intentions. One wonders though, how should healthcare move forward resolving such conflict? Which way? Better yet, how? Let’s ask healthcare professionals their thoughts and tips for resolving conflicts in healthcare.
[su_box title=”Key Takeaways”]Conflict is nothing new in healthcare. The myriad of factors and stakeholders interests in complex systems like healthcare meant resolving conflicts is never easy. For our patients sake, moving forward meant these conflicts need resolution. Conflict resolution though was rarely tackled in med school or training. In this chat, we will ask healthcare professionals their tips and thoughts on resolving conflicts in healthcare.[/su_box]
T1. Have you experience conflict in healthcare work environment? Share your most challenging conflict and how you feel about it.
Emotions play a vital role in resolving conflicts. How we handle our emotions affects our ability to handle conflicts. One thing I learned over the years, never try resolving a conflicts when blood is boiling in your arteries!
T2. How did you resolve your most challenging conflict? What was the feeling after resolving this conflict?
Calm conversations with various stakeholders helps in conflict resolution or even in moments of disagreement. I am still learning the four step “The Walk in the Woods” method used in the nuclear arms negotiations between US and Russia. The steps include articulating stakeholders self interests, overlapping/enlarged interests, enlightened interest or disagreements, and aligning interests or (dis)agreements. These are not very easy steps but the feeling of relief afterwards is liberating!
T3. Share three (3) of your most important and effective tip for resolving conflicts in healthcare.
Listening play a big role in conflict resolution. Listening for the four “interests” I mentioned above helped me understand the nature of conflicts I’ve encountered. Putting yourself in the shoes of the other stakeholder (humility) also helped a lot. It’s fascinating how emphatic we can be if we put on the perspective of others in conflict resolution. Pause, if you have time and your emotions are boiling, also plays a vital role in conflict resolution. In most of my high tension conflict resolutions I face, it helped a lot when stakeholders take a “pause” from lengthy emotionally demanding conversations. I take a break often, walk, or do something unrelated just to free up my mind and emotions. Nowadays, I practice meditation during these conflict resolution breaks.
Join #HealthXPh on this conversation at “X” (twitter) this saturday May 18, 2024 9PM Manila time, with this topic, “Resolving Conflicts in HealthCare”, with these guide questions. Don’t forget to append “#HealthXPh” to every tweet/answers you make in the conversation. See you!
