Book contents
- Frontmatter
- Contents
- Contributors
- Acknowledgments
- Introduction
- PART ONE DEFINING MEDICAL PROFESSIONALISM
- PART TWO CASES INVOLVING MEDICAL STUDENTS
- PART THREE CASES INVOLVING PHYSICIANS
- 3 Principle of Primacy of Patient Welfare
- 4 Principle of Patient Autonomy
- 5 Principle of Social Justice
- 6 Commitment to Honesty with Patients
- 7 Commitment to Patient Confidentiality
- 8 Commitment to Improving Quality of Care
- 9 Commitment to Maintaining Trust by Managing Conflicts of Interest
- 10 Commitment to Professional Responsibilities
- APPENDIX: Cases by Specialty
- Index
- References
3 - Principle of Primacy of Patient Welfare
Published online by Cambridge University Press: 25 February 2010
- Frontmatter
- Contents
- Contributors
- Acknowledgments
- Introduction
- PART ONE DEFINING MEDICAL PROFESSIONALISM
- PART TWO CASES INVOLVING MEDICAL STUDENTS
- PART THREE CASES INVOLVING PHYSICIANS
- 3 Principle of Primacy of Patient Welfare
- 4 Principle of Patient Autonomy
- 5 Principle of Social Justice
- 6 Commitment to Honesty with Patients
- 7 Commitment to Patient Confidentiality
- 8 Commitment to Improving Quality of Care
- 9 Commitment to Maintaining Trust by Managing Conflicts of Interest
- 10 Commitment to Professional Responsibilities
- APPENDIX: Cases by Specialty
- Index
- References
Summary
PATIENT WELFARE – ADULT PRIMARY CARE
A family physician recommends that an eighty-two-year-old woman with a history of coronary disease take the non-steroidal anti-inflammatory (NSAID) drug celecoxib (Celebrex) for osteoarthritis. The physician chooses celecoxib over a non-Cox 2 inhibitor because of his concern about NSAID-induced gastropathy. Celecoxib requires prior authorization and the physician is aware that the insurance company only allows use of this drug when a patient has tried and is intolerant of other NSAIDs. The physician forwards a note to the insurance company indicating this to be the case, despite the fact that the patient has not tried other NSAIDs.
A Perspective from a General Internist
Clinical Background
Each year, the use of NSAIDs, including aspirin, accounts for a significant amount of gastrointestinal complications, mainly gastric ulcers and gastritis. These complications lead to an estimated 7,600 deaths and over 70,000 hospitalizations in the United States. Factors listed in Table 3.1 have been shown to increase the risk of NSAID-induced gastropathy.
The average duration of NSAID use before the onset of GI symptoms is twelve weeks. The longer the duration of NSAID use, the higher the risk of gastropathy.
There is an approximate 1 percent absolute risk reduction for symptomatic ulcer disease when using celecoxib compared to other non-COX-2 inhibiting NSAIDs over a one-month duration.
- Type
- Chapter
- Information
- Professionalism in MedicineA Case-Based Guide for Medical Students, pp. 115 - 153Publisher: Cambridge University PressPrint publication year: 2009