Wednesday, April 7, 2010

Journal Club

This morning, I will be leading a journal club discussion for the Yale-New Haven Hospital emergency medicine residency. The topic is "Fight or Flight in the Face of Epidemics: Making a Case for Codes of Ethics." We will be looking at some of the ways codes of ethics succeed in shaping physician behavior and where they might break down.

As an icebreaker, I am asking my colleagues to put themselves in the context of various disasters to think about how they might respond. Since all three questions are New Haven-themed, I thought I would pose them here, as well!

1. A SARS-like illnes broke out in NYC two weeks ago. There are 76 fatalities, including five physicians and 7 nurses. Boston just reported its first death, and there are 5 patients in YNHH with the disease. Will you:

A. Volunteer for MICU coverage
B. Come to work as usual
C. Call in for backup
D. Head for the hills

2. The Indian Point (north of NYC) nuclear reactor's cooling system was sabotaged by an environmental terrorist group, resulting in a meltdown that was not properly contained. New Haven is in the predicted fallout area, but the extent is still unknown. Will you:

A. Sign up for surge (ED surge that is) duty
B. Work for the first few days, then leave town
C. Avoid the chaos entirely

3. Hurricane Zelda slams Long Island Sound in a late season perfect storm situation. Manhattan experienced a storm surge of 15 feet, incapacitating the health care system in NYC. New Haven has flooding, but the hospitals still function. FEMA and the military are looking for docs to staff tent hospitals. Would you:

A. Stick around to treat the victims of this disaster
B. Get out of harm's way but stay close enough to help radiation-contaminated victims
C. Take an extended holiday yo the West Coast

... and now, your answers please!


  1. As a civilian (not a doctor), I'd kind of hope as many doctors as possible would stay behind to help as much as possible in all cases. But that is kind of an arrogant presumption on my part that all doctors would put the good of all humanity above their own concerns for their health, their family, etc. What if you, as a doctor, are the only person who could get your elderly parent to safety? Yet, in taking care of that one relative, you render yourself unable to provide your medical skills to scores of strangers?

  2. These are the sort of questions we must consider... And when docs are faced with real dilemmas in emergencies, as Anna Pou did post-Katrina, there is sometimes no 'right' answer.