Ethics Corner

Kamal Ibrahim, MD, FRCS(C), MA
Ethics and Professionalism Committee Chair

The committee publishes in each issue of the newsletter a case of possible ethical or professionalism dilemma and invites members to send their comments. Please send your comments to [email protected]. The committee will collect all responses, summarize and publish them in the next newsletter. In this newsletter, the committee presents a case of professionalism relevant to second opinion consultation.

Dr. Smith is a well-qualified spine deformity surgeon who works at a major, but not teaching, medical center. The hospital treats adults and children alike. Its medical staff has all specialty and subspecialty physicians, but all are in private practice with independent offices at different locations, many of which are not on the medical center campus. Dr. Smith has been in practice for 10 years with a great reputation among the staff of this medical center.

Dr. Smith saw Tina, a 10 year old girl with 35 degrees scoliosis. After a complete work up was done, he ordered a brace for her. Initial response to the brace was satisfactory but in spite of good compliance the curve progressed to 50 degrees at the age of 11 and half years thus Dr. Smith recommended surgery for spine fusion. The family had a good rapport with Dr. Smith and agreed but asked for a recommendation for a second opinion. Dr Smith recommended three spine deformity surgeons. The family chose Dr. Jones.

Dr. Jones is a full time academic faculty at the medical school in the same city and works at the children’s hospital, which is well respected and affiliated to the medical school. He has been in practice approximately three more years than Dr. Smith. Dr. Jones saw Tina and after reviewing the history, examining her and reviewing her entire radiological file, he agreed the only option is surgical fusion. Dr. Jones tells the family that although he agrees with Dr. Smith’s opinion he believes this surgery should be performed at a university hospital and with a more experienced surgeon, such as himself. He had a patient in another room that had fusion two months earlier and he brought her in to tell Tina about her experience. By the end of the visit, the family was very ambivalent about the decision. They like Dr. Smith and believe he is capable but at the same time they have developed second thoughts as a result of Dr. Jones’ discussion. However, what the family decided to do is not the focus of this discussion!

The focuses of primary concern are the professional issues involved:

1. Was Dr. Jones honest enough in rendering his opinion about Dr Smith and his medical center, knowing this surgery is performed at many non university hospitals all over the world?
2. Was he appropriate in trying to lure a second opinion patient his way and bringing another patient to share her own experience and assist him in his goal?
3. Is this unprofessional behavior or acceptable, since Dr. Jones didn’t break any ethical principle?

Please send your opinion to [email protected]. The committee will review all responses and publish their summary in the subsequent newsletter.

Chair: Kamal N. Ibrahim Committee: John P. Lubicky, Hilali Noordeen, Brent D. Adams (C), Jason Bernard (C), Ryan D. Muchow (C), Timothy S. Oswald, James M. Eule, Timothy A. Garvey, H. Robert Tuten, B. Stephens Richards III, Jochen P. Son-Hing, MD, FRCSC