Ethical Dilemmas in Physicians’ Consultations with COPD Patients

Abstract

Jonina Sigurgeirsdottir,1,2 Sigridur Halldorsdottir,3 Ragnheidur Harpa Arnardottir,3– 5 Gunnar Gudmundsson,1,6 Eythor Hreinn Bjornsson2 1Faculty of Medicine, University of Iceland, Reykjavik, Iceland; 2Pulmonary Department, Reykjalundur Rehabilitation Center, Mosfellsbaer, Iceland; 3Faculty of Graduate Studies, School of Health Sciences, University of Akureyri, Akureyri, Iceland; 4Department of Rehabilitation, Akureyri Hospital, Akureyri, Iceland; 5Department of Medical Sciences, Respiratory-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden; 6Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, IcelandCorrespondence: Jonina Sigurgeirsdottir, Pulmonary Department, Reykjalundur Rehabilitation Center, Furubyggd 28, Mosfellsbaer, 270, Iceland, Tel [phone], Email [email protected]: This phenomenological study was aimed at exploring principal physicians’ (participants’) experience of attending to COPD patients and motivating their self-management, in light of the GOLD clinical guidelines of COPD therapy.Methods: Interviews were conducted with nine physicians, who had referred patients to PR, five general practitioners (GPs) and four lung specialists (LSs). The interviews were recorded, transcribed, and analyzed through a process of deconstruction and reconstruction.Results: The participants experienced several ethical dilemmas in being principal physicians of COPD patients and motivating their self-management; primarily in the balancing act of adhering to the Hippocratic Oath of promoting health and saving lives, while respecting their patients’ choice regarding non-adherence eg, by still smoking. It was also a challenge to deal with COPD as a nicotine addiction disease, deal with patients’ denial regarding the harm of smoking and in motivating patient mastery of the disease. The participants used various strategies to motivate their patients’ self-management such as active patient education, enhancing the patients’ inner motivation, by means of an interdisciplinary approach, involving the patients’ significant other when appropriate, and by proposing PR.Conclusion: The findings indicate that being a principal physician of COPD patients and motivating their self-management is a balancing act, involving several dilemmas. Patients’ nicotine addiction and physicians’ ethical obligations are likely to create ethical dilemmas as the physician is obligated to respect the patients’ will, even though it contradicts what is best for the patient. The participants suggest strategies to motivate COPD patients’ self-management.Keywords: physicians, physician-patient relations, physician’s role, COPD, self-management, motivation, patient education, qualitative research, interviews

Keywords

• physicians
• physician-patient relations
• physician's role
• copd
• self-management
• motivation
• patient education
• qualitative research
• interviews.