How would you address a situation where physician demands compromise patient well-being?

"What you permit, you promote." Patient welfare and well being is the moral and ethical foundation for the practice of medicine. In a well functioning organization it is the bedrock of behavior for all employees from the front desk to the support staff to the providers to the CEO. Having established this ethos throughout an organization allows the organization to approach challenging corrective actions based on the ethos rather than focusing on an individual person. "You are a fine physician and a great member of our team, but that is not how we do things here. How can we change things going forward to align with our obligation to our patients?"

This is a red line that cannot be crossed if patient care is being compromised. Here are two real-life examples I've seen. 1. Surgeons pre-documenting surgeries before the procedure is performed. The surgeons argued that the op-report could always be amended if things didn't go as planned. Pre-documentation may violate standards but doesn't compromise patient care. The surgeons were encouraged not to pre-document to avoid disciplinary actions. 2. Primary care doctors running a weight loss clinic allowed non-physicians (e.g., medical assistants or nurses) to authorize patient prescriptions at presentation or follow-up visits. Here, the doctor crossed the red line, putting patients at risk. I had to dismiss the offending provider.

I fully agree with the text above, but there are few times when patients should be harmed in any way due to physician demands. We physicians all took an oath to do no harm, and that certainly governs intentional omission of necessary (or commission of unnecessary) actions on any patient’s behalf. Negotiating desired changes is a skill, and every group should endeavor to obtain training in the techniques. With committed bargaining, many issues can be resolved without compromising patient care and safety.

True. But the responsibility of physician is also crucial to ensure that the patient thoroughly perceives the plan. So, raising a couple of questions and giving answers by physician could be quite helpful.

Primeiro, eu convocaria uma reunião com a equipe médica para discutir as demandas e como elas estão impactando o bem-estar dos pacientes. Em seguida, promoveria um espaço aberto para que todos pudessem compartilhar suas preocupações e sugestões. Juntos, buscaríamos soluções que equilibrassem as necessidades do médico e o cuidado com o paciente, garantindo um ambiente de trabalho saudável e focado na qualidade do atendimento.

I’m a firm believer that Doctors have the patient’s well being in mind as do nurses. That said at times when there are clearly issues with an order or behavior I’m a patient advocate first and foremost. I will seek clarification from the doctor and seek to understand coming from a place of understanding that the doctor doesn’t want to hurt his patient. In the end if I still think the issue requires escalation I will show evidence of why I take issue with whatever the problem is. Showing documentation of your point is helpful. I’ve used published journals, drug guides and Medical books to make my point. In the end Doctors are on the side of the patient as I am and on the occasions that I’ve had to do this, those Drs appreciated it.

Once you’ve fully understood the situation, it’s crucial to communicate your concerns in a way that fosters collaboration. Begin by respectfully outlining the facts, focusing on the patient’s well-being without implying blame or judgment. Consider the physician’s perspective, and frame the conversation around shared goals—ensuring the best patient outcome. Being direct but tactful allows you to highlight potential risks without making the other party defensive. Your aim should be to open a constructive dialogue, paving the way for collaboration that benefits the patient while maintaining professional integrity.

En estos momentos siempre es muy útil transmitir la idea principal de que. Somos empáticos con el otro profesional de salud y que sabemos que Todo médicoo busca siempre el bienestar de sus pacientes....Y dando por sentado esa premisa, debe arrancar cualquier conversación entre colegas

apresente suas preocupações ao médico de maneira clara e respeitosa. Utilize uma abordagem construtiva para comunicar suas preocupações sobre o bem-estar do paciente. Mantenha o profissionalismo, evitando ataques pessoais e reações emocionais. Foque nos fatos e no impacto no atendimento ao paciente para iniciar um diálogo produtivo que possa resultar em melhorias no cuidado oferecido.

Once you have a grasp on the situation, it's time to speak up. Share your concerns openly and respectfully. The goal is to ensure patient well-being, so being clear and straightforward is crucial. Sometimes, doctors might not realize how their decision affects patients—communication is everything.

If direct communication fails to resolve the issue, it’s essential to escalate the matter through proper institutional channels. Engaging with higher authorities or consulting the ethics committee ensures that the concern is managed with appropriate oversight. These committees exist to address conflicts that may affect patient care, providing a structured environment for resolving disputes. Involving senior medical staff or legal counsel may offer additional perspectives, ensuring the issue is handled in line with hospital policy. This approach protects both the patient and professional integrity, fostering a collaborative resolution.

Utilize protocolos estabelecidos, como envolver o comitê de ética ou consultar a equipe médica sênior. Seguir esses procedimentos assegura que a questão seja abordada adequadamente e com o suporte dos recursos institucionais.

Collaborating effectively with the physician and healthcare team is key to ensuring patient safety without straining professional relationships. Approach the situation with the goal of finding a mutually agreeable solution by leveraging the expertise of the entire team. Brainstorming alternative treatment options or modifying the care plan can help address the physician's concerns while ensuring patient well-being. This team based approach fosters trust, promotes open communication, and ensures that all members feel their input is valued, ultimately leading to the best patient outcomes.

Los médicos debemos siempre estar claros de que los conceptos y abordajes son dinámicos y cambiantes, para lo cual debemos mantenernos actualizados y tener mentalidad flexible para ofrecer mayores posibilidades en pro de la salud del paciente, siempre tomando en consideración la mejor evidencia científica posible

Brainstorming de abordagens ou tratamentos alternativos pode abordar as preocupações e garantir a segurança do paciente. A colaboração promove um ambiente de equipe onde a experiência de todos é valorizada para o benefício do paciente.

Working together with the physician to find a middle ground can often help. The idea is to brainstorm other ways to meet the doctor’s goals without compromising patient care. Everyone wants the same thing—good outcomes—so it’s about finding that balance together.

In situations where patient well-being is at risk, it's critical to document all communications and actions taken in detail. This includes noting conversations with the physician, guidance from senior staff or committees, and outcomes of any interventions. Such documentation not only ensures accountability but also serves as a valuable record should the situation escalate or require review. A comprehensive record helps clarify the decision making process, protects all parties involved, and ensures transparency, which is essential for maintaining professional standards and patient safety.

Es crucial documentar cada decisión de manera rigurosa y basada en evidencia científica. Esta documentación no solo respalda las acciones del profesional de salud, sino que también demuestra que sus decisiones están fundamentadas en su conocimiento y juicio clínico. Al justificar cada intervención con criterios científicos, el médico asegura que, ante cualquier eventualidad, sus acciones estuvieron guiadas por un enfoque ético y orientado al mejor interés del paciente.

Ante esta situación es como en cualquier otra situación médica. Siempre es indica, es fundamental respaldar todas las acciones, decisiones y análisis por escrito, ya que es el documento Médico-legal que a futuro ante cualquier otra situación puede ser la mejor evidencia.

When dealing with sensitive situations, keeping a record of what was said, decided, or suggested is a must. It doesn’t have to be anything too formal but make sure you’ve got the details down in case questions arise later. Documentation keeps things clear and accountable.

El seguimiento, monitoreo e implementación de protocolos son indispensables para evitar recurrencias en este de tipo de casos. Los. Comité de ética son muy útiles para estas situaciones

Don’t just assume the problem is solved. Circle back after the decision is made to ensure everything is working out as expected. Follow-up ensures that no detail slips through the cracks and that patient safety remains the top priority. It shows you’re thorough and committed.