Robert D. Truog, MD, aims to stimulate moral imaginations with this year’s John J. Conley Ethics and Philosophy Lecture, Microethics: The Ethics of Everyday Practice, at 9:00 am Wednesday, October 7. The lecture will be available for on-demand viewing through the virtual ACS Clinical Congress 2020 meeting platform through December 31.
Dr. Truog is the Frances Glessner Lee Professor of Medical Ethics, Anaesthesia, & Pediatrics and director, Center for Bioethics, Harvard Medical School, Boston, MA; and senior associate in critical care medicine, department of anesthesiology, critical care, and pain medicine, Boston Children’s Hospital, MA.
Physicians make ethical decisions in every conversation they have with a patient, Dr. Truog said, and this is the heart of microethics.
“Not everybody is going to share the bias that more information is always better,” he said. “You can adjust the way you talk with patients so that you’re at least aware of the fact that you are bringing certain biases into these conversations and maybe moderate your conversations depending on who you’re talking with.”
When physicians are taught communication skills, they are taught to elicit the preferences of the patient. However, Dr. Truog wants physicians to consider the possibility that patients don’t have formed preferences about the medical decision they might be facing and may not have considered the issue at hand until now. In those cases, it’s highly likely that the physician-patient conversation is the catalyst for the patient developing a clear preference regarding the information necessary to make informed decisions.
“It is a very powerful role that we are in because our own biases, our own preferences can heavily determine what the patient will end up endorsing as their own preferences,” he said. Because of this, it is crucial that physicians are aware of their own unconscious biases, so they don’t project them into every conversation they have with patients.
“Not all patients want or need the same amount of information,” Dr. Truog said, likening it to dosing medication. “Some people need larger doses, some people need smaller doses. The same thing can be true with the information that we provide.”
When patients and surgeons think about the surgical profession, they tend to focus on technical skills and medical knowledge. As physicians mature and become more comfortable in what they do, Dr. Truog said there is an increasing recognition that surgeons’ time outside of the operating room can be the most powerful in terms of the influence that they have on patient lives.
“These conversations where they’re helping patients decide to have an operation or not are, in many ways, even more important than how the operation actually goes,” he said. “You assume the surgeon is going to do the operation well, but the decision making that goes up to that point can really be the most important decision making.”
This lecture is sponsored by the Committee on Ethics and has been generously supported since 1991 by John J. Conley, MD, FACS, to explore ethical issues in surgery. Dr. Conley died in 1999, but his legacy continues and his memory is honored through this annual presentation.