Letter Three–Angeli

The third week of my project and things are picking up. I have all my physicians lined up for the last two weeks and I am excited. There is another pediatrician and a family medicine physician.

Having seen another pediatrician has really helped me with my mindset for this pediatrician and has prepared me. This pediatrician runs a tight ship seeing, almost 30 patients on her busiest day. Unlike the previous physicians, this one has no new patients and thus spends less time overall with each patient.

It was interesting though because despite spending about 10 minutes with each patient (much less time than the previous physician), it felt as though she had spent a large amount of time with her patients and give them a lot of individual attention. She was able to address all their issues and showed almost every marker of respect. The patients as well as their parents clearly respected her and liked her. My previous hypothesis that the amount of time spent was clearly correlated to the amount of respect physicians show patients was untrue in this case.

This observation leads to the question that my research hopes to lead to: Can these types of behavior be reproducible by all physicians? The physician who had perfected the balance between medicine and business had found the happy medium between having happy, healthy patient-doctor relationships and being a successful small business owner. She also had many more years of experience practicing medicine and running a private practice. But I would be curious to understand how she learned this.

I know that medical ethics is a course that is taught in medical school and even I had to undergo a lot of HIPAA training to do research in the Duke School of Medicine. But are these classes helpful? Can ethics really be taught and can biases really be eliminated from medical students or are these classes really just helpful in showing the consequences of poor ethical choices? I think that this has caused me to think about a few more questions to consider.

As time has passed, more things have become apparent about how I would like to revise my research methods in the future. My research is qualitative rather than quantitative in nature. This may make it more difficult for me to interpret my results, as my analysis will need to be deeper than just studying the numbers I gathered. I felt that the best course of studying medical ethics was through a comprehensive research methodology that consisted of both observations, which had no input from the physician and a formal interview where physicians could elaborate on their personal experiences as well. As this was a more elaborate research method, I knew that I would have a smaller sample size than most qualitative research requires. This research article that I had read prior to designing my research procedure helped me understand the importance and difficulty of qualitative research: Ethical Challenges of Researchers in Qualitative Studies: The Necessity to Develop a Specific Guideline (But, I had felt that was my main limitation.)

As I discussed the idea and concept of my research with another physician, they noted an interesting point: there is a secondary limitation in my research protocol that I never considered. It is the fact that all the physicians who are in my sample size have agreed to be part of my research and know that I am observing them. This is known as the Hawthorne effect. As a neuroscience and public policy double major, it is really interesting to see how the things I am learning about medical ethics and research itself are becoming more interdisciplinary.

I don’t think that these limitations can be addressed in this research project with the way it is structured. But it was something that I had not thought about and may limit the variety of data that I collect. As I continue shadowing physicians and through the interview process, I will think about what I would do in the future if I wanted to combat these limitations.

I will be conducting all my interviews next week. So that is what the focus of my next letter will be. I am excited to see how the final week of my project in the United States wraps up.