First, Do No Harm

In this episode, we interview Dr. Alan Dow, the Seymour and Ruth Perlin Professor of Medicine and Health Administration, Assistant Vice President of Health Sciences for Interprofessional Education and Collaborative Care at VCU, and Interim Chair of the Division of Hospital Medicine at VCU Health. We discuss the ethical challenges and complexities associated with working in a large healthcare team to drive patient-directed care, and the importance of using key concepts in interprofessionalism to help address these issues. We also talk about the challenges of implementing interprofessionalism practices at the individual and institutional level, and how to integrate these practices into the hospital workflow.

In this episode, we interviewed Dr. Danielle Noreika, Palliative Care physician and Director of the Hospice and Palliative Care Medicine program at VCU, about the intersection of palliative and hospice care and what makes this area unique with respect to medical ethics. The discussion explores the ethics of defining comfort versus life-prolonging care, especially with respect to withdrawing versus withholding life prolonging care for comfort measures, and how to communicate effectively with the patient and their family on end of life care issues. We also reflect on how successful outcomes are objectively measured within the field of palliative care since it differs from most other specialities in medicine in dealing with complex medical issues and ethical dilemmas.

In this episode, Karishma interviews Dr. Jason Karlawish, Professor of Medicine, Medical Ethics and Health Policy, and Neurology at the University of Pennsylvania Perelman School of Medicine. We discuss the bioethics of aging and Alzheimer's as well as the recent controversial FDA approval of aducanumab to help treat Alzheimer's disease. We explore issues from the implications of aducanumab's approval on care and treatment of patients with Alzheimer's, how it will impact prescribing habits, and the shared decision-making process between providers and the patient and their caregivers.

In this episode, we interviewed Dr. Rodas, Trauma and Critical Care Surgeon and Director of VCU Program for Global Surgery at VCU Health, Director Acute Care and Systems Strengthening in Low Resource Settings (ACCESS) at VCU SOM, and President of the Cinterandes Foundation, to discuss global health ethics. We discuss the lessons Dr. Rodas has learned in his global health work with the Cinterandes Foundation, such as the importance of addressing social determinants of health and barriers to accessing care in addition to practicing medicine. We also discuss the ethical issues commonly seen in global work, including the pitfalls and short-term benefits medical mission trips provide a community and how to overcome these issues with long term engagement with a community. The conversation centers around the ethical principles of beneficence, non-maleficence and justice and how these are applied in prioritizing allocation of limited resources in global health and global surgery.

In this episode, we interviewed Dr. Amendola, Chief of the Division of Vascular Surgery at the Hunter Holmes McGuire VA Medical Center, about the role of ethics within surgery and explore a few ethical scenarios surgeons face that differ from other fields of medicine. We discuss the importance of informed consent, patient-centered decision-making, and navigating the unique bond between patient and surgeon in a historically paternalistic field. Surgeons often do not discuss ethics despite encountering difficult decisions that frequently require the use of ethical principles, especially those of autonomy, beneficence, and non-maleficence. We reflect with Dr. Amendola on how the field can improve on its discussion of surgical ethics and the importance of training the next generation of healthcare professionals to learn about these issues.

We interviewed Dr. Posner, Professor Emeritus of Vascular and Transplant Surgery and former Director of the Hume-Lee Transplant Center at VCU Health, to discuss the ethics surrounding the distribution of human organs and the patient factors that influence organ allocation. What variables should be considered when trying to maximize a patient's benefit from an organ transplant? What improvements can be made to the current system of allocation to pursue a more equitable system? The origins of transplantation have a rich history, from its inception in the “God Committee” to current allocation systems and this episode endeavors to discuss the historical perspective of transplantation and how changes in this system have benefited and/or hindered patients seeking transplant.

In our first episode we asked Dr. Levenson, Professor of Psychiatry and Chair of the VCU Health Hospital Ethics Committee, to share the main principles of medical ethics, common ethical scenarios in healthcare, and how patients can better advocate for their needs. The ensuing discussion was enlightening and helped us better understand the need to empower patients. We hope that our listeners will also learn strategies for advocating for themselves as they better understand the ethical commitments that their physicians have made.

Welcome to our podcast, “First, Do No Harm,” where we discuss interesting ethical issues in healthcare and the challenges healthcare workers face in addressing complex situations and ethical dilemmas that arise when taking care of patients in various fields.