Ethics and the Medical Record

TO THE EDITOR:

We wholeheartedly support Dr. Tauber's concern for improving patient care and the physician–patient relationship [1]. However, we believe his proposal for a separate section in the medical record for ethical issues is problematic. Our chief objection is that virtually every aspect of clinical medicine is replete with ethical implications. Relegating selected ethical issues to a separate section in the medical record could easily encourage a minimalist view of ethics. Rather than trying to increase ethical sensitivity through requiring separate documentation, we believe this goal can be attained only by making systemic changes in medical education and by rewarding ethical awareness in clinical practice. Possible steps include 1) improving support for teaching behavioral sciences and ethics in the undergraduate medical curriculum and residency training, emphasizing the integration of these concepts throughout clinical practice; 2) increasing attention to the psychosocial aspects of the patient's life in the medical history so that understanding of the patient's life and illness in the context of family, community, and employment will be integrated into the body of the physician's notes; 3) mentoring junior physicians, modeling the values of compassion, respect for patients, and ethical sensitivity; 4) encouraging and rewarding ethical practices among attending physicians, residents, students, and administrators; and 5) developing relevant and valid instruments to evaluate skills in medical ethics.