Browsing by Subject "Moral Community"

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    Approaches and Moral Considerations of a Liver Transplant Team to Conflict About the Treatment of Complications
    (2018-05) Scheiner, Nathan
    Research on the approach to disagreement among patients and providers has generally focused on internal medicine providers. High levels of emotional intelligence and empathy among individual internists appear to confer increased adherence to treatment plans and satisfaction among patients. These qualities may help maintain long-term physician-patient relationships. In the few studies examining surgeons, emotional intelligence, but not empathy, results in increased patient satisfaction only. Some therefore suggest that the clearly defined and short-term relationship between surgeon and patient subverts the need to foster deep empathetic understanding and trust for long-term follow-up. Transplant surgery may be a unique surgical sub-specialty for its use of scarce resources, and because patients are followed over the long-term by interdisciplinary teams of providers. I present the results of a qualitative study suggesting transplant teams may function more like internal medicine teams than other surgical sub-specialties, because transplant social workers and nurses foster trust and empathy, reducing conflict among and between team members and patients. I analyzed the narratives of six liver transplant team members at a large academic medical center in the Midwest. I define the sources of conflict perceived by transplant team members, which extend beyond treatment non-adherence, and their underlying moral understandings. I also describe the importance of trust-building, and the role of the transplant team as a moral community, which functions to examine and decide upon conflicts that arise over broad contexts. These results suggest interdisciplinary transplant teams take on some of the emotional work typically performed by individual internal medicine physicians.