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LEARNING OBJECTIVES

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  1. To define integrity and accountability as they relate to the practice of medicine.

  2. To describe the importance of integrity and accountability as core elements of the social contract between the profession and society.

  3. To outline behaviors that demonstrate integrity and accountability.

  4. To describe the contribution of the team and the system to integrity and accountability.

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INTRODUCTION

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Dr. Porter was suddenly struck by an awful thought—he realized he had made a mistake on a prescription he wrote for a patient in the emergency department. It was toward the end of a very busy shift and one of the last patients he saw had a clear-cut case of cellulitis. As he has done dozens of times before, he wrote a prescription for cloxacillin, handed it to the patient, and carried on. While reviewing charts at the end of his shift he suddenly noticed that the patient had a documented penicillin allergy. In a panic, he asked the nurses whether the patient had left. One nurse thought she saw the patient heading toward the pharmacy, so Dr. Porter went to look. He saw the patient speaking with the pharmacist—they had caught the error and were just about to call Dr. Porter. He was so relieved! He thanked the pharmacist and apologized to the patient for the mistake. Together, they reviewed the patients' allergy history and selected a different antibiotic that was safe. The patient, although at first quite upset, was really pleased with the way the pharmacist and the doctor handled the issue, and appreciated Dr. Porter's apology.

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WHAT ARE INTEGRITY AND ACCOUNTABILITY?

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Integrity can be defined as, “A virtue consisting of soundness of and adherence to moral principles and character and standing up in their defense when they are threatened or under attack. This involves consistent, habitual honesty and a coherent integration of reasonably stable, justifiable moral values, with consistent judgment and action over time” (Miller-Keane & O'Toole, 2003). In healthcare settings we can define integrity as encompassing honesty, keeping one's word, and consistently adhering to principles of professionalism, even when it is not easy to do so. Accountability usually refers to reliability and answering to those who trust us, including our patients, colleagues, and society in general. Dr. Porter demonstrated these attributes when he took responsibility for the error, corrected it, and apologized to the patient.

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WHY DO INTEGRITY AND ACCOUNTABILITY MATTER?

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Integrity and accountability are fundamental to ensuring trust between the public and healthcare professionals. Physicians' integrity forms a foundation for patients' trust and fosters healthy therapeutic relationships that promote healing. Integrity and accountability form the basis of the “social contract” between physicians and society, which grants professionals the privilege of self-regulation. Indeed, as history has shown, this social contract is fragile—if we do not maintain this trust the contract can be rescinded. Perhaps the best-known example of the fragility ...

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