1. 0 Serving the Best Interests of the Patient Patient Care & Ethical Dilemmas

2. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Disclosure  The speaker has no financial interest in the subject matter of this presentation and is not representing the Ethics Committee of the American Academy of Ophthalmology with this presentation.  For questions about the material contained herein or about the Academy’s ethics program in general, please contact the ethics program manager, Mara Pearse Burke at ethics@aao.org.ethics@aao.org

3. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Why is this Topic Important?  Integrity of the Profession  Engenders Patient Trust  Acting in the Best Interests of the Patient  Putting the Patients’ Needs Before Your Own

4. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Case Study 1  Dr. M is a 1 st year Ophthalmology resident at a busy inner-city program in Boston.  He is on call for the first time at the ER of the county hospital and is called to see a patient with an unidentified traumatic eye injury.

5. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Case History  Dr. M examines the patient and is unclear how to manage his care, so he decides to take pictures of the patient’s injury – one close-up and one full-face -- to post on Facebook hoping for treatment advice from his fellow residents.

6. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Case History  After receiving a number of comments via Facebook, Dr. M contacts the senior resident on call and, upon her advice, admits the patient to the hospital for further care.  The daughter of the patient asks Dr. M for his email address and they become Facebook “friends”.

7. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Case History  The patient’s daughter soon sees her father’s pictures on Dr. M's Facebook page and is upset that her father’s condition has been made public. She immediately contacts hospital administration.  The Residency Program Director of Dr. M’s residency is contacted.  Dr. M is suspended for violating HIPAA

8. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY What Do You Think?  Are images of patients on social media ever acceptable? Yes, if the picture is de-identified per HIPAA requirements.  Are there other ways in which Dr. M could have sought his fellow residents advice in this situation? Emailing the de-identified pictures to a secure receiving account is possible.

9. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Case Study 2  A patient is scheduled for routine, outpatient, elective cataract surgery. The attending and you (a 2 nd yr. resident) will perform the surgery  The patient is so informed and expresses understanding.  During the surgery, a crack develops in the IOL implant.

10. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Case History  The problem is immediately recognized, but not disclosed to the patient. All other aspects of the surgery are as expected.  Post-operatively, the patient has no symptoms from the cracked IOL and recovers with good vision and no apparent problems.

11. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY What Do You think?  Should the resident or attending disclose the error to the patient?  If so, when?  Yes, the patient must be informed of the problem as soon possible after her surgical procedure.

12. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Obligation to be Truthful Experts agree that if the wrong IOL is placed, ophthalmologists should tell patients the truth promptly in a detailed, open discussion and give an apology. Patients should actively participate in the discussion about methods to resolve the issue and manage further care.