December 6, 2009 Panelists:

Seven Deadly Sins of Professionalism 1. Abuse of power / lust 2. Arrogance / Anger 3. Greed 4. Conflict of interest / pride 5. Misrepresentation / envy 6. Impairment / substance abuse / gluttony 7. Lack of conscientiousness / sloth / “pwede na” Dr. Andrew Lee Prof. of Ophthalmology

A Second Opinion Video: A patient seeking a second opinion It is not clear what the second doctors opinion is of the patient’s illness The second doctors opinion of the first doctor – “Dr. Taga, Dr. Patay” What is the sin? (arrogance, greed, conflict of interest, misrepresentation)

Issues on Second Opinions What is the patient’s right to a second opinion? If you were the first doctor? 1. I always encourage my patients to ask for one 2. I am the best, no second opinion is needed

Issues: Who should you send your patient to for a second opinion? 1. I will send my patient to my friend who will not steal my patient 2. I will first ask the patient if he knows any other surgeon, if not, I will recommend someone (better than I am?) 3. I am obliged to send my patient to an expert 4. I will send my patient to my enemy because it is a complicated case

Issues: If you were the second surgeon and the diagnosis or planned treatment is Obviously Wrong, how would you tell it to the patient? 1. Give a derogatory opinion on the qualifications of the first surgeon esp. if not a diplomate or fellow of PCS 2. Never give derogatory remarks How should one tell the patient that the diagnosis or treatment plan of the first surgeon is wrong?

Issues: What if your opinion is the same? 1. I will say that the first surgeon is credible and send the patient back to him 2. I will sell myself to the patient (I am better actually, choose me!) 3. I will let my patient choose freely without any unnecessary comments (good or bad)

Issues: The patient is actually just shopping around for a “Cheaper Surgeon” 1. I will lower my actual fee to a level lower than the first surgeon 2. I will lower my actual fee to match that of the first 3. This is my fee, “Take it or leave it!”

Issues: The patient finally chooses you for whatever reason. 1. I will inform the first surgeon that I am taking over his patient 2. I will ask the patient to tell the first surgeon 3. There is no obligation on my part or the patient to inform the first surgeon

I Know How to Do It? Patient consulting an ophthalmologist The patient needs an operation The patient learns of a new procedure which he chooses to be performed on him The surgeon claims he can do it. Without the knowledge of the patient, the surgeon calls an expert friend to do it with him. Fee is split after. What Sins? (Misrepresentation, conflict of interest, greed)

Issues: If you were the surgeon on the video? 1. I will do the same, there is nothing wrong about it (the patient will receive proper care anyway) 2. I will tell the patient the truth and send him to an expert 3. I will tell the patient the truth but will tell him I have a colleague who I can call to help me do it

Issues: What if you are the second surgeon? 1. I will do it for my friend anytime 2. It is ok to do it if I don’t receive any fee, I am helping a friend 3. I will do it only if the patient is properly informed

Issues: The patient is properly informed. On the matter of the professional fee of the “helping surgeon” 1. Should just let the first surgeon decide on the amount 2. Should charge separately for his services 3. Should not charge at all

Issues: What should be the institutional safeguards against “Ghost Surgery” Credentialing: There should be individual accreditation for specific operations that a surgeon is allowed to do Sanctions for erring surgeons?

I’m the Boss! Parking in a no parking zone, obstruction of driveway The late surgeon – tardiness Unwanted sexual advances The angry surgeon in the OR What are the sins? Abuse of power, arrogance

Issues: Obstruction of driveway, no parking: 1. I am the boss, I can do whatever I please 2. Sorry, I was in a hurry just this time 3. I will never do this, the boss should set a good example

Issues: The late doctor, tardiness 1. I am the boss it is only right that people wait for me 2. Doctors are busy people and it is understandable that they may be late once in a while 3. I make it a point that I come on time as a show of respect for other people’s time

Issues: Unwanted sexual advances: 1. You’re over reacting, I’m just being playful, it’s harmless! 2. It’s ok if it’s between consenting adults 3. It’s just not proper, period.

Issues: The angry surgeon in the OR, disruptive behavior 1. Surgery is stressful work, it’s ok for him to lose his temper (Sometimes? All the time? He’s the boss) 2. I am the captain of the ship. I have a right to be angry if the members of the team are not performing up to par 3. People tend to be more alert when I am angry 4. I can get what I want without being angry

Issues: What are the institutional safeguards against these unwanted behaviors in the department level or higher? 1. Departmental rules and regulations 2. Ethics committee 3. Quality assurance 4. Legal department 5. Others?