ethical practice

You don’t need to be a licensed PA to begin practicing ethically.

I recently received a letter from a woman (I will call her Joan) who found Inside PA Training while researching the ethics of shadowing.  Her letter brought forth all kinds of feelings for me, and I think it’s a great way to discuss ethical practice in medicine.

Dear Paul,

I recently had an appointment with an orthopedic doctor for knee issues. After I had my vitals checked and was wearing paper “shorts,” the PA came in and introduced herself and the very young lady with her as her assistant.  I had to ask what this “assistant” had to do with my care and it was only then that the truth came out.  She did not ask me if I was okay with a shadowing student in the room.


Joan requested the student to leave.  She told me that she had already been a patient in a similar situation once before.  She felt that these episodes demonstrated a lack of professional conduct and common courtesy, and that they ruined the sense of trust that she had with her provider.

I hope that in your shadowing you will be prepared for such a situation and take the ethical position.  As a medical professional, you will, on a daily basis, be trusted by your patients to protect their interests, including their privacy.

No matter your role, I hope that in all your interactions with patients you will treat that trust as a gift and not misuse it.

The worst part about this story (to me) was not that the shadowing student represented herself as an “assistant.”  It was that any licensed provider — in this case a physician assistant — would misrepresent someone else who has no training and no official capacity as anything other than what they really are.  Obviously the provider felt that if she was vague enough, the fact would be glossed over and the patient would get what they wanted while the student did too.  Unfortunately, things didn’t work out that way.

Again and again research on the ethics of healthcare has shown that the earlier students are introduced to practicing ethically, the more ethically they are likely to practice.  It starts with supervisors setting good examples.  But alas, if you study medicine you will sometimes have a bad role model, so…

If you are asked to do something that you are uncomfortable with or that you believe is unethical, be ready to say “I’m not comfortable with that.” These words may displease the person who told you to do it.  Say them anyway.

At this point you may be saying “Duh.  I would definitely tell them I can’t do it.”

But it’s harder than it sounds. Have you heard of the Milgram experiments?  They are some of the most famous experiments in psychology.  Stanley Milgram was a social psychologist whose research in the 1960’s demonstrated that the majority of people will hurt and/or endanger someone they do not know because someone else with authority — someone wearing a white coat — told them to.  In an ironic twist of fate, though famous, Milgram’s experiment is now considered unethical itself because his subjects were potentially scarred by the revelation that they would hurt others so easily.  Click here to watch video on these fascinating experiments.

There are all kinds of ethical problems that come up when you examine stories like Joan’s.  She mentioned was how she wasn’t given a choice to have the student present or not.  This is violation of the ethical rule of patient autonomy.  Can you identify any that I’ve left out?

What you can learn from a licensed professional’s mistake

(Before you even start your training)

  1. Respect your patient’s right privacy
  2. Be honest with patients at all times
  3. Be willing to say (politely) “I don’t feel comfortable doing that.”
  4. Involve your patients in the decisions that affect their care whenever possible.
  5. Finally, be open to learning from your patients.*

*Dear Joan,

I’m sorry that you had such an experience.  On behalf of the PAs of the world (if I may be so bold), I apologize.  Thank you for taking the time to share your story — I’m sure it will improve our work with patients.    -PK