Bringing the special perspective of the family physician to the teaching of clinical ethics.

BACKGROUND

Medical ethics has traditionally been taught using dramatic, out-of-the-ordinary cases to illustrate principles. Little attention has been focused on the ethical decisions family physicians make routinely in the course of their practice.

METHODS

As part of a multidisciplinary course in medical ethics at the University of Washington School of Medicine, one class section was taught by a family physician using cases from her primary care practice. Cases were presented up to the point of decision making. Students were then encouraged to consider what action they would take. Each case was concluded with the family physician sharing the outcome of the case.

RESULTS

Five case examples were presented. A comprehensive, context-sensitive approach to patient problems was modeled. Ethical issues explored included financial constraints, resource utilization, substance abuse, truth telling, confidentiality, and patient autonomy.

CONCLUSIONS

Case-based teaching by a family physician was very effective at generating interest and enthusiasm among students and in encouraging their own thinking about ethical decisions. Students also valued the exposure to the family physician's style of practice. This teaching method created an excellent opportunity for learning about ethics and primary care that is applicable to many teaching settings.