Truth-telling: what did you think?

At some point you may see something going wrong in a patient's care. What are you supposed to say? How should you say it, and to whom?

Sociologist Parker Palmer, Dr. Paul Batalden, Dr. David Leach, and Dr. Emma-Samelson Jones (a newly-minted physician) tackled this question during today's On Call. David Leach presented a case in which a resident was on her twelfth day on the ward, single-handedly overseeing 34 patients. A transplant patient under the resident's care faced complications and died during her shift. Later, a group of residency directors was asked, "Who was the moral agent in this case?" The question was met by silence.

Emma then told a story from her student days, recalling a patient who, in her view, was being treated unfairly. When Emma spoke up on the patient's behalf, her preceptor "got a stony look on his face."' The relationship never recovered, and Emma requested to work at a different clinic. She did not see the patient again. In this story, Emma was the moral agent -- but her agency was unwelcome.

1. Do you have a story like Emma's or the resident's? What happened?
2. Have you ever challenged a senior colleague? Did it make you feel more empowered or more discouraged in your profession?
3. Have you seen someone in your organization act as a “moral agent?”
4. How can educators change their teaching to empower students to bring their values to work?

Join the discussion by clicking the "comments" link below. The audio recording of this call is coming soon to www.ihi.org/openschool. In the meantime, check out these related resources written by the presenters:
Change Magazine article by Parker Palmer: A New Professional: The Aims of Education Revisited
Activity by Paul Batalden and David Leach: Becoming a "Moral Agent"
Organ donation case submitted by Paul and David: Knowing Is Not Enough
Pulse Magazine article by Emma Samelson-Jones: Brain Cutting