This latest addition to the QHC Case Collective features a case, key points, and resources from Episode 4 of the QHC Podcast, recorded 5 June 2026. I interviewed Dr Bethany Erb to investigate how clinicians’ communications with each other about patients express habits of moral perception that can have short- and long-term influences on moral motivation and professional development.
Case
This composite case from Dr Erb’s experience takes place on a busy hospital inpatient service. A senior resident physician relays clinical and other information about a middle-aged woman with poorly controlled diabetes. Before entering the room, a resident physician describes the patient as “difficult,” apathetic about her health, minimally health-literate, and nonadherent to clinical recommendations offered during prior hospital admissions.
Members of the clinical team enter the patient’s room and she is withdrawn and visibly uncomfortable. When asked about her insulin and other medication adherence, she breaks eye-contact and explains that, due to recent job loss, she struggles to pay rent. She answers most questions using only single words. The encounter is brief and feels brusk to some members of the team, especially to one student, who notices that clinicians who visit the patient later that day seem to communicate with her as little as possible, offer few explanations, and spend little time soliciting the patient’s views about decisions that need to be shared and made. The student notes that, though no clinician explicitly mistreats the patient during any single clinical encounter, her care plan and how it is executed and managed seem negatively influenced by how the patient is characterized by some members of the clinical team.
The student wonders about legacy effects of those early, negatively toned communications on the quality of this patient’s care throughout the duration of her hospital stay.
Ask 4 questions.
In Moral Reasons, from 1992, Jonathan Dancy argues that what a moral agent “construes as salient” in a situation’s “moral landscape” express a moral agent’s habits of moral perception and constitutes their moral motivation to act in that situation.
- Which features of the “moral landscape” of this case should be viewed as salient, by whom, and why?
In The Virtues in Medical Practice, from 1993, Edmund Pellegrino and David Thomasma draw on conceptions of virtue from Aristotle and Alasdair MacIntyre to forge an overall argument for virtue as a practice that express values that constitute one’s personal and professional character over time.
- What might a moral agent’s speech or tone of speech suggest about their patterns of moral perception, what motivates them to act, who they are, and who they are becoming as persons and professionals?
- When clinicians describe patients as “difficult,” what should we ask about how clinicians see their roles in patient-clinician relationships or about how clinicians see their professional obligations to (a) steward therapeutic capacity in those relationships and (b) help patients derive value from the health systems and services available to them?
- What should be the nature and scope of roles health professions educators play in guiding how health professions students are transformed into clinicians worthy of trust from individual patients and members of the public?
Resource
“The Use of Force” is a short story included in The Doctor Stories by William Carlos Williams, first published in 1932.
Views expressed in this podcast episode reflect the personal views of individuals and do not necessarily reflect official policies or positions of the Defense Health Agency, Department of Defense, or US Government.
The feature image for this post is available from the Creative Commons Public Domain collection of the Art Institute of Chicago. Learn more about this work here.
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