Observations Ethics Man

Seven ways to hone your ethics skills

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2911 (Published 08 May 2013) Cite this as: BMJ 2013;346:f2911
  1. Daniel K Sokol, honorary senior lecturer, medical ethics and law, King’s College London, and practising barrister
  1. daniel.sokol{at}talk21.com

In developing clinical technique, don’t neglect the “softer” skills such as ethics

As an amateur magician, whenever I find the time to practise I focus on technical sleights. In front of the mirror I repeat the same move again and again. I transfer a coin from one hand to the next, blow on the fist, and—boom—it vanishes. I wipe my hands together to show that the coin is gone. I repeat the process until it becomes second nature, or until boredom kicks in.

The problem is that, in my zeal to master the technique, I neglect the “softer” skills. I spend barely any time on words and gestures that should accompany the effect. As a result of my skewed emphasis, I am a technically proficient but average magician.

In medicine the temptation is also to focus on technique in the quest for self improvement. Junior doctors seek to add to their portfolio of procedures, and the “softer” ethical skills are given short shrift. Here are seven ways for doctors to hone their ethical skills.

1. Read about medical ethics

The basic text for all doctors is the ethical guidance of the General Medical Council. After that, the choice is yours. An old but excellent introduction is Raanan Gillon’s Philosophical Medical Ethics,1 written by a doctor for doctors. There are many books devoted to specific specialties, from the comically named Ethics and the Kidney to Neonatal Bioethics.2 3 I shall abstain from referring to my own volume, Doing Clinical Ethics: a Hands-on Guide for Clinician and Others.4 Reading a single book on medical ethics will, in itself, set you apart from most of your colleagues.

2. Attend a course on medical ethics

Several masters courses in medical ethics are available in the United Kingdom; some are one year full time and some two years part time. Before enrolling, check whether the course has a practical, philosophical, or legal slant. If you are unsure whether you can commit for one or two years, look for one of the shorter courses in medical ethics, such as Imperial College London’s annual five day intensive course in medical ethics. A number of one day courses are also available throughout the year. The website of the Institute of Medical Ethics has a helpful list of events and courses (www.instituteofmedicalethics.org/website).

3. Reflect on ethical issues in your own practice

Clinical ethics is a practical discipline. Armed with your newfound knowledge of ethics, you should apply it to your own practice. Just as in clinical procedures, the more cases you reflect on and analyse, the better and quicker your analysis will become. When I first encountered the “four quadrants” approach,5 a framework for examining an ethical problem, I took every opportunity to use it on real and hypothetical cases. I immersed myself in the method.

4. Join a clinical or research ethics committee

Joining a committee will present you with a range of ethical problems from which to develop your analytic skills and give you opportunities to articulate your views and assess those of colleagues. A list of clinical ethics committees appears on the UK Clinical Ethics Network website (www.ukcen.net/index.php/committees). There are currently 69 research ethics committees in England. Consult the National Research Ethics Service for more details on these committees (www.nres.nhs.uk/about-the-national-research-ethics-service/about-nres/who-we-are/).

5. Give a presentation or develop a poster on medical ethics

It will take courage to deviate from your usual comfort zone but will pay dividends later as you become known as an authority on the subject and, with luck, start receiving invitations to speak at study days, departmental seminars, grand rounds, and conferences. As with articles, have a clear structure, such as “facts,” “identification of issues,” “analytic framework and analysis,” and “conclusions.”

6. Write an article on an ethical problem

Every doctor with more than a few months’ experience of the job has at least one case or anecdote that could form the basis of an ethics article. Or, once you have given the presentation in the previous section, consider transposing the talk into an article. It could be for a general medical journal such as the BMJ or your specialty journal or even a newsletter or magazine. Dozens of medical ethics journals, such as the Journal of Medical Ethics and Clinical Ethics, welcome good articles from clinicians. One idea when starting is to get an ethicist on board. He or she will know about suitable journals, will identify any gaps in the literature, and will ensure that the language is appropriate. Ethicists, like clinicians, have jargon. Approach your local medical school to obtain the name of an ethicist.

7. Teach ethics to medical students

It is well known that teaching a subject is a great way to learn it. A good lecture is informative, relevant, clear, non-threatening, and entertaining. Use photos, videos, and any other props, as well as anecdotes, to maintain interest. Again, contact the ethics lead of the medical school and express your desire to teach the occasional session. At first you may wish to teach alongside an ethicist.

Notes

Cite this as: BMJ 2013;346:f2911

Footnotes

  • Competing interest: Raanan Gillon was my PhD supervisor. I am the author of Doing Clinical Ethics. I co-direct a short course in clinical ethics.

References