With that an introduction, we have a guest blogger joining us today. Dr. Mark Komrad of Sheppard Pratt Hospital joins us for a post and asked if we'd reprint a piece he wrote for the MPS newsletter. Without further ado:
by Mark S. Komrad M.D.
I want to argue that a requirement in ethics training for physicians in general, psychiatrists in particular, should be implemented, in parallel with the already established requirements of social workers and psychologists. Historically, physicians were long resistant to the idea of medical ethics as an important clinical discipline. There was a sense that it belonged as a course in philosophy departments or at special “think tanks” like the Hastings Center for Bioethics in New York, but not in hospitals, on rounds, or in grand rounds. However, that recalcitrance was gradually eroded, partly with the help of the Joint Commission on Accreditation of Health care Organizations (JCAHO) which, over the last decade, has started to require that hospitals have an Ethics Committee, which could be consulted by staff or patients. Even prior to this, the federal government instituted the requirement of an Institutional Review Board (IRB) to review any protocol for human experimentation for ethical soundness.
The fact is that mandating continuing education in ethics for social work and psychology produced a market for such courses, and suddenly, they were commonly available. In my experience, they are eagerly attended, not simply because they are mandated. Attendees seem to find this training of immediate value to common practice conundrums. These seminars actually help to raise basic awareness of when one is actually on ethically controversial ground-- a basic awareness that, though fundamental, is often lacking. It is one thing to know how to skate on thin ice; it is another thing entirely to learn how to recognize that the ice is getting thin.
More than any other kinds of healing professionals, therapists and psychiatrists are often soloists. What we do is, by necessity, very private. Typically, we are utterly alone with our patients. This makes us vulnerable to creating a hermetically sealed zone in which our clinical judgment is deployed, without being readily accessible to feedback from other authoritative colleagues or sources. My work on the MPS Peer Review Committee demonstrates to me the kind of “judgement trance” that can be fostered, in which progressive rationalizations can lead to a subtle, gradual drift away from standard ethical practice. Unfortunately, it is often left to the patient or family member to ring the alarm bell, signaling that the psychiatrist is “off-the-reservation.” One need only read the report of sanctions by the Maryland Board of Physicians to see that psychiatrists are overly-represented in that roll call of dishonor.