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The problems of communication, and the ethical and legal issues that arise daily for physicians, rarely occur singly or in isolation. The problems occur in the context of an increasingly complex health-care system. It has been said that “the environment of care has evolved into a difficult and complex setting filled with poor communication, unclear policies, role confusion, turf battles, and stressful interpersonal conflicts.” (Gerardi, D., 2004) The scenarios in this module illustrate some of these issues, particularly the interaction between the individual and the organizational system, both in a hospital and in a private office. One scenario illustrates the problems of confidentiality in a large institution, and the hierarchy of power among physicians. The other, set in a private office, focuses on management issues and limitations of competence.
An important issue in each scenario is the sense of discomfort each of the characters’ experiences. Often, we focus on the work of diagnosis and management, and either do not notice the discomfort or choose to ignore it. However, such psychic discomfort is usually an indication that something is going on that we should pay attention to. Identifying the source of these feelings can prevent conflict and/or miscommunication. As you move through this module, pay attention to the discomfort each character experiences and try to describe it.
Each scenario in this module has exercises designed to provoke your thoughts on how you might act in similar situations.