Category Archives: Medical School

Notes on the Ethics of Reflection

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Sharon A. Dobie MCP, MD

It is important that we reflect and write about the work we do with patients. As we reflect, we create a narrative that sometimes becomes a written piece. We cannot really tell our stories without including the patients because it is actually our perception of the patients and their stories. And yet, we also have a covenant of confidentiality with our patients. Beyond what HIPAA says, we live within ethical considerations that must protect our patients.

What then can we do when we write and then want to share that writing with a friend, in a blog, or for a journal submission?

When writing about patients, we must respect these ethical considerations. In an evolving set of guidelines, the best practice remains to show what we write to the person about whom we wrote. That is what I encourage writers to do whenever possible. It can be scary and it is always fruitful. You might learn more about the story, about the person, about yourself, and the bias inherent in your viewpoint. That information might lead you to add to or edit your reflection. Then what you have is a co-creation, and your patients will feel valued and respected. Alternatively, these conversations may also clarify reasons to not publish the piece.

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What If Prince Had a Waivered Family Physician?

By Matthew Martin, PhD and the members of the STFM Group on Addictions

A Prince in Crisis

On April 21, at 9:43 am, the Carver County Sheriff’s Office received a 911 call requesting that paramedics be sent to Paisley Park. The caller initially told the dispatcher that an unidentified person at the home was unconscious, then moments later said he was dead, and finally identified the person as Prince. The caller was Andrew Kornfeld, the son of Howard Kornfeld, MD, an addiction medicine specialist from Mill Valley, CA. Andrew, a pre-med student, had flown to Minneapolis with buprenorphine that morning to devise a treatment plan for opioid addiction. Emergency responders tried to revive the musician but later pronounced him dead at 10:07 am.

On April 20, the day before, Prince’s representatives contacted Dr Kornfeld, who agreed to see Prince later that week. Dr Michael Schulenberg, a family physician in Minneapolis, saw Prince on April 7 and April 20 apparently for opioid withdrawal. However, Dr Schulenberg is not a waivered physician and thus could not prescribe buprenorphine. If he had, perhaps Prince would now be recovering in a comfortable treatment center in California receiving state-of-the-art medical care. He would likely be receiving buprenorphine treatment to prevent opioid withdrawals. Recent autopsy results show that Prince died from an accidental overdose of Fentanyl.

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The Three Services I Want to Provide to My Patients

Lara Baatenburg

Lara Baatenburg

We all have those areas of life where we just feel incredibly out of place and like we are standing like deer in the headlights. For me, this is going to the mechanic. I’m always nervous to bring my car in; what if there is something wrong with my car and I can’t afford it, what if the mechanic tries to pull a fast one on me, what if, what if, what if? I recently had to go to my mechanic, and he proceeded to list all the things wrong with my car. As I stood there nodding my understanding I was really thinking that I had no idea what he was talking about. He was using words I didn’t know, explaining about parts of the car I had never heard of, and the list of my ignorance goes on. Obviously I know nothing about vehicles, but I don’t want him to know that!  When he finished and asked if I had any questions I responded confidently, “Nope, you did a great job of explaining that, thank you,” when really I had no idea what to ask because since I only understood maybe 10% of what I was told, forming any question was difficult.

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