The scene is the examination room of an orthopaedic surgeon. A patient, whose capitated insurance requires a referral from a primary caregiver to a specialist, has obtained an appointment with a previously visited orthopaedic surgeon. The patient is complaining about lower back pain and suggests that the primary caregiver is not likely to give him a referral to an orthopaedist. He asks the orthopaedic surgeon to call the primary caregiver and ask permission for the visit and diagnostic testing, neither of which may be clinically indicated.
The orthopaedist explains that he, like the patient must obey the rules of the managed care system. He cannot call the primary caregiver; the patient has to make an appointment with the primary caregiver.
Stop the video.
The scene is from "Ethical Issues in Orthopaedic Surgery." Ten brief video scenarios present clinical ethical dilemmas ranging from managed care issues to conflict of interest cases. After each case is shown, participants in an ethics course are urged to discuss the case.
The video was developed by Neil S. Wenger, MD, and Jay Lieberman, MD, of the departments of medicine and orthopaedics, University of California, Los Angeles. It is being used to teach ethics to UCLA residents.
"Today's health care delivery environment and new technology presents many ethical challenges to orthopaedists," says Dr. Lieberman. "The video exposes all the facets of the many ethical dilemmas faced today." The video and a discussion handbook, priced at $220, are available through the Academic Orthopaedic Society, (AOS), 6300 N. River Rd., Rosemont, Ill. 60018.
On May 21, 1999, the Academy Board of Directors approved a recommendation of the Ethics Committee to use the video as a prototype for developing a series of videos depicting ethical issues orthopaedists face and how to address the issues. The series would be provided to orthopaedic residency programs by the Academy, American Orthopaedic Association and AOS.