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Your scenario is as follows:
Dr. Jamison, a 73-year-old internist, has long been a respected physician in the community. Yesterday morning, his patient, Ms. Swenson, arrived at the hospital’s emergency department complaining of shortness of breath. The emergency department admitted her for follow-up testing. Dr. Randall, a younger physician on staff, is covering for Dr. Jamison today. In reviewing Ms. Swenson’s chart, he notes that although Dr. Jamison had seen his patient on the floor following her admission, he had not ordered an electrocardiogram or other appropriate follow-up tests. Dr. Randall comments about this to the nurse on the unit, who then confides that during the past several months, she and several other nurses on the floor have noticed moments when Dr. Jamison has seemed confused and did not know where he was supposed to go. That reminds Dr. Randall of a recent committee meeting at which Dr. Jamison had difficulty following the discussion. When a committee member half-jokingly said, “Hey, Bill, pay attention,” Dr. Jamison laughed it off saying he had been up late reading about a difficult case.
Dr. Randall is concerned that Dr. Jamison may be experiencing an impairment affecting his clinical ability and that his patients may be at risk. He is understandably uncomfortable at the prospect of confronting a well-respected senior colleague about the quality of the medical care he is providing. However, if, as he suspects, Dr. Jamison’s episodes of confusion and forgetfulness are due to age-related cognitive decline, impairment will likely continue.
The other framework I want this group to investigate is the Pause Decision Making
The next category of looking at whether the issue is a moral one or an ethical one?