What Is It Exactly That You Do? An Introduction

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In 1998 two colleagues and I published, in this journal, a report of the activity of an ethicist in a large teaching tertiary medical center over a period of a month. The title of the article is ‘‘What is it exactly that you do? A ‘snapshot’ of an ethicist at work’’ (Ehleben et al. 1998). I was the ethicist subject in the 1 month snapshot and my co-authors were the Director of Graduate Medical Education (Saltzman) and the Director of Research (Ehleben) at the Georgia Baptist Medical Center in Atlanta, Georgia (now Atlanta Medical Center and owned by Tenet Health). In re-reading this brief report I am struck with how in many ways we were naive about what ethicists do and how they might do what they do. On the other hand, in light of more detailed and disciplined studies done by others in the past 10 years or so including those essays published in this current issue, I am struck with how similar the work we did in Atlanta 15 years ago is to what I and most of my Clinical Ethics Consultant (CEC) colleagues are doing today and which has been the subject of so much discussion especially when the discussion comes to the topic of credentialing CECs and accrediting their training. When I was beginning the ethics program in Atlanta, I was expecting that most of my time would be in providing nursing and house officer (GME) education and that consequently most of the formal ethics consultations would be generated through the nurses and residents and perhaps patients and families after being told that there was such a service. It proved to be true that the majority of my time was spent in education but not of the classroom variety. Nor did the majority of the requests for formal consultations come from the nurses and residents. Attending physicians requested consultations two times more than any other group in the medical center. In addition, we found that most of the education that was provided is what we might describe as curbside consultations. Attending physicians, nurses and residents