The Compass
Medical Practice Should Not Require the Stripping Away of One’s Self
As a hijab-observing Muslim, I devote myself to living modestly, a practice requiring constant diligent attention to approach this ideal. My attire is the most visible manifestation of this commitment as I cover my head and body when around people outside my family (non-mahrams). The awrah—required areas of coverage—are more extensive for non-mahram males. I never go out in public without covering my arms.Medicine’s Blind Spot
My fingers graze the top rack of my wardrobe, hunting for the familiar texture of my favorite suit jacket. I find it and can’t help but chuckle, wondering if it looks anything like I envision. I don the jacket along with its matching trousers, a crisp white shirt, and a pair of heels. Most would consider this overdressed for a doctor’s appointment, but it’s an ingrained habit. For me, a sharp look is my first line of defense against the negative attitudes others will have of me, simply because I lack a sense deemed vital.Transforming Diversity, Equity, and Inclusion in Medical Education—Mayo Clinic Alix School of Medicine
Mayo Clinic is committed to eliminating racism and reducing health care disparities. Without systemic change, these inequities compound and detract from the very patients and communities we serve. Racism limits the ability of learners, staff, and faculty to do their job and to be their full authentic self in clinical and learning environments. An effective path toward equity requires elimination of systemic barriers for both patients and staff. To do so, we must embrace opportunities to learn what is actually needed to improve their experience.Research Involving Participants With Impaired Consent Capacity: An Examination of Methods to Determine Capacity to Consent
To examine methods of assessing consent capacity in research protocols involving participants with impaired consent capacity, and examine instruments used to evaluate research consent capacity.Physician Well-being 2.0: Where Are We and Where Are We Going?
Although awareness of the importance of physician well-being has increased in recent years, the research that defined this issue, identified the contributing factors, and provided evidence on effective individual and system-level solutions has been maturing for several decades. During this interval, the field has evolved through several phases, each influenced not only by an expanding research base but also by changes in the demographic characteristics of the physician workforce and the evolution of the health care delivery system.The High Stakes of Outsourcing in Health Care
Outsourcing in health care has become increasingly common as health system administrators seek to enhance profitability and efficiency while maintaining clinical excellence. When clinical services are outsourced, however, the outsourcing organization relinquishes control over its most important service value: high-quality patient care. Farming out work to an external service provider can have many unintended results, including inconsistencies in standards of care; harmful medical errors; declines in patient and employee satisfaction; and damage to clinicians’ morale and income, and to the health organization’s culture, reputation, and long-term financial performance.A Longitudinal Study Exploring Learning Environment Culture and Subsequent Risk of Burnout Among Resident Physicians Overall and by Gender
To explore the relationship between learning environment culture and the subsequent risk of developing burnout in a national sample of residents overall and by gender.Self-Valuation Challenges in the Culture and Practice of Medicine and Physician Well-being
To compare physicians with workers in other fields on measures of self-valuation (SV) and determine the effect of adjusting for SV on the relationship between being a physician and risk for burnout.Racism in Pain Medicine: We Can and Should Do More
The long history of racism in the United States, including racist medical practices, has strongly influenced Black people’s perceptions of health care delivery for generations. Unethical practices have included the performance of painful procedures without anesthesia on enslaved Black women by J. Marion Sims in the 1840s, the Tuskegee study that intentionally withheld effective treatment from Black men with syphilis in the 1930s through the 1970s, and the sterilization procedures performed without consent (“Mississippi appendectomy”) on Black men and women as recently as the 1970s.Achieving Racial Equity Within Medical Institutions: An Appeal for Action
In late May 2020, a global outpouring of grief and rage swept our world as news emerged that George Floyd, an unarmed Black man in police custody, was publicly murdered on a busy street in Minneapolis. The cruel and casual disregard for Mr Floyd’s humanity as he cried for his mother has since haunted our public conscience, shattering widely held perceptions of a color-blind, post-racial era. Intractable structural racism—the sum of interwoven social policies, institutional practices, and cultural norms that systematically discriminate against persons of color1—continues to exact a terrible toll in all areas of our lives: the criminal justice system and mass incarceration, housing, education, food security, transportation, and indeed health care.Breaking Down the Web of Structural Racism in Medicine: Will JEDI Reign or Is It Mission Impossible?
Soon after the first reported US case of coronavirus disease 2019 (COVID-19) in January 2020, the pandemic piled on centuries of adversities from systemic racism and social injustice in communities of color. Then, on May 25, 2020, George Floyd, an unarmed Black man, died from being pinned at the neck to the ground in handcuffs by a hand-pocketed White police officer, sparking outrage globally, effects of which were captured in a Black community study.1 A flurry of antiracism statements ensued, but in February 2021, the Journal of the American Medical Association posted a podcast and tweet asserting that “no physician is racist.”2 My experience tells me differently.Listening to Sounds of Gratitude
With its unrelenting demands on our time, talent, and treasure, the arduous academic journey and personal sacrifices necessary to become a medical doctor are well known within the medical profession. Both the odyssey and the crucible of medical training refine our thoughts and character and forge such strong bonds and respect among our colleagues; it is the tie that binds. From myriad paths and backgrounds, we arrive at our status as physicians to form a team tenaciously dedicated to the health care needs of our patients.Silence in the Noise: Journey With Hearing Loss Across 2 Worlds
“You do not have middle ears!” exclaimed my middle schooler as our conversation evolved into chatting about the special sense of hearing and balance while discussing the letters of Helen Keller. The following narration describes the reminiscences during conversations that ensued over the next week or so at the dinner table with my wife and our 8- and 12-year-old daughters.Stress and Fear: Clinical Implications for Providers and Patients (in the Time of COVID-19 and Beyond)
In light of the coronavirus disease 2019 pandemic, we explore the role of stress, fear, and the impact of positive and negative emotions on health and disease. We then introduce strategies to help mitigate stress within the health care team, and provide a rationale for their efficacy. Additionally, we identify strategies to optimize patient care and explain their heightened importance in today’s environment.Compassion in a Crisis: The Role of Palliative Care During the COVID-19 Pandemic
The disruption to health care delivery introduced by the coronavirus disease 2019 pandemic suggests a near-term future very different from a few months ago. Among the many lessons learned are the value of preparing for unpredictable medical events and the need for high-human-touch health care when serious situations arise.Shell Shock and PTSD: A Tale of Two Diagnoses
Ever since human beings first went to war, the people who fight in those wars have sustained not only physical wounds but also psychological wounds, which may spare the body but scar the mind. And for almost as long as human beings have been waging war, societies have struggled with two fundamental questions about these psychological wounds. First, how do we identify and define these unseen wounds, wounds that lead to the type of consequences that defy simple physiologic explanation? Second, given that some people clearly return from war with psychological issues that impair their ability to function, how do we justly compensate those who experience these psychological wounds (an issue that becomes particularly salient as the number of people affected increases)?Resuscitation and COVID-19: Recalibrating Patient and Family Expectations During a Pandemic
As humanity grapples with the social, economic, and political disruption caused by the coronavirus disease 2019 (COVID-19) pandemic, many healthcare systems across the globe have been working to set appropriate expectations for patients being treated during these challenging times. As of June 8, 2020, there are close to 2 million COVID-19 cases in the United States with 112,000 deaths [coronavirus.jhu.edu]. As patient volumes increased, healthcare systems and state and federal governments scrambled to address critical shortages of COVID-19 test kits, personal protective equipment, pharmaceutical drugs, and medical equipment such as mechanical ventilators.Disorders of Consciousness and Disability Law
In 2018, the American Academy of Neurology, the American Congress of Rehabilitation Medicine, and the National Institute on Disability, Independent Living, and Rehabilitation Research published a systematic evidence-based review and an associated practice guideline for improved assessment, treatment, and rehabilitation of patients with disorders of consciousness. Patients with disorders of consciousness include individuals in the vegetative and minimally conscious states, as well as others with covert consciousness and cognitive motor dissociation.Developing an Ethics Framework for Allocating Remdesivir in the COVID-19 Pandemic
On May 1, 2020, the US Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) to allow use of the antiviral drug remdesivir to treat patients with severe coronavirus disease-2019 (COVID-19). Remdesivir is an investigational drug studied in clinical trials for COVID-19 and is available to children and pregnant women through compassionate-use access but is not yet FDA approved. In early May, the US Department of Health and Human Services began to distribute remdesivir, donated by Gilead Sciences, Inc., to hospitals and state health departments for emergency use; multiple shipments have since been distributed.COVID-19 Ethics and Research
As of April 27, 2020, the coronavirus disease 2019 (COVID-19) pandemic involved 2,916,338 reported cases and had claimed 205,923 lives.1 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spreading in almost every country, causing widespread health challenges and social instability. People most vulnerable to COVID-19 include those with underlying health conditions.2 Yet the pandemic is disrupting clinical trials addressing these same health conditions.3 There were more than 300,000 studies being conducted worldwide registered on clinicaltrials.gov.Public Health Crises and the Human Subjects of Biomedical Research: A Focus on COVID-19
The widespread social and economic disruption caused by the novel coronavirus disease 2019 (COVID-19) is clearly apparent and has affected all walks of life. The biomedical research enterprise is no exception. According to the 2015-2016 Global Participation in Clinical Trials Report published by the US Food and Drug Administration (FDA),1 there were 40,385 clinical trial participants in the United States during that time period. Given exponential advances in biotechnology, it is expected that this number has grown considerably over the past 5 years.Ethical Considerations About Clinician Reimbursement for Advance Care Planning
The Centers for Medicare and Medicaid Services (CMS) introduced 2 Current Procedural Terminology (CPT) codes that allow clinicians to bill for time spent discussing advance care planning (ACP) effective January 1, 2016. As defined by Sudore et al,1 ACP is “a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care….[with] the goal…that people receive medical care that is consistent with their values, goals and preferences during serious and chronic illness.” Proponents applauded this new policy as a method to incentivize ACP, potentially increasing the uptake of ACP and thereby improving the delivery of medical care that aligns with the patients’ goals, values, and preferences.Reexamining the Ethics of Human Germline Editing in the Wake of Scandal
In November 2018, the announcement that genetically edited human embryos had been used for reproductive purposes caused international uproar; many observers argued that editing the human germline was unethical, particularly given the early stage of the science and the absence of appropriate oversight. We provide an overview of the implications of these events, focusing on the relevant ethical considerations for physicians addressing patient questions and concerns. The editing of the human germline for reproductive purposes should be understood against an historic backdrop of clinical research in assisted reproduction, as well as other exemplars of translational investigation.Association Between Public Trust and Provider Specialty Among Physicians With Financial Conflicts of Interest
To characterize public perception of physicians’ conflicts of interest (COIs) across medical and surgical specialties.Treatment Over Objection—Moral Reasons for Reluctance
Clinical ethics dilemmas often emerge at the intersection between the preferences of patients or their families and what physicians think best promotes patients’ interests. The standard ethics guidance attempts to resolve these kinds of dilemmas by means of a 3-part stepwise progression of decision-making criteria. First, when patients possess “decision-making capacity”—when their treatment preferences reflect relatively sound reasoning and an understanding of their clinical situation—they are usually permitted to select suboptimal treatments.
