Question

On Thursday night Dr. Jones was at home watching television and spending time with his family. The phone rang. The South Shore General Hospital ER physician asked him to see an urgent patient. Dr. Jones replied that he was not on call for the emergency room at South Shore General Hospital, and furthermore, the hospital was paying members of a competing group to cover the emergency room. The emergency room doctor said that he was aware of the arrangement with the competing group. However, the ER could not reach the on-call physician and had tried for some time. Dr. Jones, who earlier had a glass of wine with dinner, responded, “You’ll have to keep trying. I’m not coming in.” The next day Dr. Jones called the Chief of Staff and the Chief Medical Officer (CMO) of South Shore General Hospital and informed them that neither he nor any members of his group would cover the ER unless they were compensated in a similar manner to the competing group and had an appropriate contractor arrangement with the hospital. Dr. Jones asked the Chief of Staff and CMO if they worked for free. Dead silence. “While you’re thinking about that question, let me say this to both of you. Doctors are working harder and longer hours and earning less money every year. Why should we give up our free time and work for nothing when you’re willing to pay the other group?”

Discussion Questions

1. What are the facts in this situation?

2. What are three organizational issues this case illustrates?

3. Was Dr. Jones obligated to go to the emergency room at South Shore General Hospital?

4. Is there an ethical dilemma in a doctor choosing not to go in to see a patient? What about the physicians who were on call? Do you think they violated any ethical principles? Or do you think this was just a matter of miscommunication? Provide a rationale for your responses.

5. If he had gone in and there had been an adverse patient outcome, how do you think the fact that he had consumed an alcoholic beverage that evening would play in a courtroom?

6. How should the ER physician have handled this matter? What is the best way to ensure emergency room coverage?

7. What steps should the administration of South Shore General Hospital take in the future to prevent this problem from occurring again?

Answer 1

1. The facts in this situation are:-

- South Shore General Hospital was paying members of a competing group to cover the Emergency room.

- South Shore General Hospital has a separate contractor arrangements for the members of competing groups with the hospital .

2. The three organisational issues illustrated by this case are :-

- longer working hours

- less payment

- injustice - separate members of competing group are made to see particular department with high pay different from what the general physicians are getting and also they have to see the assigned department ,not all the department like for general physician.

3.No , Dr. Jones was not obligated to go to the emergency room at South Shore General Hospital.

4.Yes, there is a ethical dilemma in a doctor choosing not to in to see a patient. When Dr.Jones is denying to go to emergency because of the institutional policy and also he was not obliged to see a patient in South Shore General Hospital , but at the same time he was having a ethical dilemma ,as it was against the ethics of a doctor to deny to see a patient . Here ,non- malificence and fidelity were breached because due to denial by the Dr ,it was causing harm to the patient and loss of faith which the patient had on the Dr.

The doctor's who were assigned to cover the emergency room were obligated to see the patient's in emergency room but they haven't reached the emergency and haven't carried out their responsibility. Being obligated to see the emergency , means it was their responsibility to take care the patient's of the emergency room. It was totally against the medical ethics and they have violated the main ethical principles like responsibility , non-malificence and fidelity . They need to give a proper written explanation for the what they have committed as it might had caused harmful effects on the patients if another duty doctor were not present .