I have always been intrigued by questions of ethics, particularly pertaining to health care. Plus, I am an avid reader of the New York Times Magazine segment “The Ethicist” by Randy Cohen, a column that is the Dear Abby of ethical intent. Questions submitted run the gamut from “What’s my responsibility if my cat pees on my neighbor’s carpet?” to “Do I have an ethical obligation to report a colleague having an affair with a subordinate at work?”
With this template in mind, I would like to offer my first “Ask the Hospitalist Ethicist” or “Ask the Hospitalist-thicist” for short. Hey, that actually has a nice ring to it, but try saying it fast five times.
Before I proceed, let me offer the following disclaimers. I am not a real ethicist (or Hospitalist-thicist), nor do I play one on TV. However, if anyone has a pilot to pitch to Hollywood in which they need a doctor of high moral character, I am more than willing to audition.
Second, I am exceptionally biased and, some would argue, not the gold standard of ethical behavior.
So here is my first completely fictional “Ask the Hospitalist-thicist” entry:
Boy, do you need a better name! Here is my dilemma: I am interviewing for a hospitalist position. It seems like a very good job in an established program with little turnover, and all the doctors seem happy. The pay is excellent and the workload is quite reasonable. However, I am also applying to a cardiology fellowship for the following year and will not know if I am accepted until July.
During the interview, the medical director told me that they do not hire candidates who plan to do a fellowship the next year–but beyond two years, she understands that no one can be certain of their long-term goals. So my question: The contract does not bind me to two years, nor was I directly asked if I planned to do a fellowship (and if I was asked, I don’t believe I was under any obligation to provide this information). Indentured servitude ended when residency-hour restrictions were put into place. If I sign a contract with a 120-day out clause, my reasons for getting out are mine alone. So I held my tongue and plan to sign the contract.
After all, it is possible that I won’t even get the fellowship. Ethical?
—Short-term relationship hospitalist
Somewhere in the U.S.
The Hospitalist-thicist replies:
This is a tough question, even for someone as versed in complex moral quandaries as I. On the one hand, you are correct. In most circumstances, you are under no obligation to divulge information that you are not legally required to offer.
But on the other hand–and to my way of thinking, this other hand is 10 times larger–if you take the position, you will have acted deceptively. Deception violates the “Honesty is the best policy” policy–and hey, I am a Hospitalistthicist, so would you expect me to offer any other rule? (As an aside, I have only a focused recognition in Hospitalist-ethics. Unfortunately, the ABMS still refuses to give us our own separate board!) Further, deception is rarely ethical. While I agree that tacitly withholding information and flat-out dishonesty are not the same, they are certainly close cousins.
Perhaps you do not give the medical director enough credit (as we are generally a most insightful, perspicacious lot). Maybe she would be willing to make an exception with a candidate of your caliber, particularly on the off chance that you won’t get the fellowship anyway.
And although ethics should be driven by morals, not consequences, your last few months on the job may not be all that much fun after you tell the medical director that you went ahead and accepted a fellowship, despite your little chat on that topic during the interview. And no, if I may be so bold as to anticipate your next question, you shouldn’t tell her you decided to “find yourself” by leaving medicine altogether to join a traveling circus.
Please send your questions for The Hospitalist-thicist, care of Today’s Hospitalist. And look forward to future installments in which the Hospitalist-thicist tackles such tough topics as, “I started moonlighting for another hospitalist program. Should I tell my director that I am secretly seeing someone else on the side, or keep it a secret?”