Ethics and the Health Information Professional

A young woman, approximately 35 years old, walks into the hospital library and scans the library shelves to hopefully find information in solving her difficult condition of infertility. She sees and greets the health librarian at the front desk who greets her and asks, “Hello Miss. What information may I help you find today?” The woman looks around to see if other non-medical information users are in the library. She quietly tells the librarian her infertility issue and asks if there is any information on the health implications of egg donation and the possible chances of achieving conception with this method.

A teenage girl walks into the hospital library looking anxiously around the library and at the online catalogs and computers. The girl, noticing that the computers are all being utilized by medical personnel, starts to get fidgety. The medical librarian noticing the anxious behavior, calls to her and asks, “May I help you with anything, Miss?” The girl starts to stammer, but manages to quietly tell the librarian. “I’m becoming sexually active with my boyfriend, but I need information about effective birth control methods.”

A casually, but neatly dressed 12 year old boy saunters into the hospital library carrying his school backpack. The librarian notices and smiles at him and yet surprised as she doesn’t see many preteen youth visit or utilize the health library. Unlike the previous visitors, this boy is the least self-conscious. He walks up to the librarian and says, “Hi! I was wondering if you have books on tattoos.” The librarian is surprised, but remains calm. “Did you want a book with pictures of tattoos or a book that talks about tattoos and how to stay healthy while having one?” The boy stops to think and decides if he wants to tell the librarian that he wants to get one because his friends have tattoos. “I think the book that talks about tattoo health would be helpful. My parents are okay with the idea of a nice tattoo graphic, but they are also concerned that I might be too young to have one for health reasons.” The librarian nods at him saying, “I can understand their concern, but I’ll show you two books that we have on tattoos and you can read and discuss them with your parents and make your decision from there.”

All of these scenarios involve sensitive, delicate and controversial issues concerning the information seekers’ needs. “Moral dilemmas are a frequent and seemingly unavoidable aspect of librarianship.” (Buchanan, Henderson, & Hauptman, 2009). Fortunately for these fictional information seekers/users, the health information professional was able to serve them with diligence, sensitivity, and understanding of their plights. However, while there are many professional health and other librarians who carry out their service and reference duties with expertise and finesse in dealing with sensitive and controversial situations, there are librarians in all information sectors who have difficulty, if not reluctance in putting their moral and personal biases aside while assisting information seekers.

According to the article, Christian Librarians and the ALA Ethics of the Library Bill of Rights (Kaihoi, S. 2015), an online study was conducted to seek opinions of librarians who self-identified as Christians of several denominations regarding the ALA’s ethical standards as embodied in the Library Bill of Rights (LBR). While 72% of the respondents in the majority supported the LBR overall, 40% of respondents differed in certain ethical areas primarily in material content such as pornography and harmful materials, etc. and believe that these “could or should be limited” especially in regard to children. According to Kaihoi, these statistics and statements “seem to suggest that many Christian librarians do sometimes perceive a need to place of the value of defending what they perceive to be true and right above the call to remain professionally impartial about certain kinds of contents.”

While I believe that these librarians’ beliefs in defending their Christian moral values and truths is commendable, I also believe that the ethics of the ALA, LBR, and the MLA codes of ethics all encourage and support the value of discernment and critical thinking in the materials that patrons and health information consumers read and watch.

The ALA, in Article II “upholds the principles of intellectual freedom and resists all efforts to censor library resources.” The LBR in Articles I-IV support the provision that “books and other library resources should be provided for the interest, information and enlightenment of all people of the community the library serves”, “presenting all points of view  on current and historical issues”,  “resisting abridgment of free expression and free access to ideas” and “should challenge censorship in the fulfillment of their responsibility provide information and enlightenment.” The MLA Code also supports these ethics as it “promotes access to health information for all and creates and maintains conditions of freedom of inquiry, thought, and expression that facilitate informed health care decisions” in its Society subheading.

References:

American Library Association. Code of ethics of the American Library Association, available at http://www.ala.org/advocacy/proethics/codeofethics/codeethics

American Library Association. Library Bill of Rights, available at http://www.ala.org/advocacy/intfreedom/librarybill

Kaihoi, Scott. “Christian Librarians and the ethics of the library bill of rights,” Theological Librarianship, v.8 no. 1, March, 2015

Medical Library Association. Code of Ethics for Health Sciences Librarianship, available at http://www.mlanet.org/p/cm/ld/fid=160

Wilkinson, Lane. Principlism and the ethics of librarianship. The Reference Librarian, v.55: 1-25, 2014 Taylor and Francis.

 

 

 

 

 

 

Comparison of Scholarly, Peer-Reviewed and Professional Journal Articles

A comparison of peer-reviewed and professional articles covering medical professionals’ perceptions of Information Sources and Services.

Peer-Reviewed ArticleThe value of library and information services in patient care:  Results of a multi-site study.

This article discusses the results of a large multi-site study that the National Network of Libraries of Medicine, Middle Atlantic Region (NN/LM MAR) conducted by forming a planning group to replicate the landmark study referred to as “The Rochester Study”. Their objective was to study the value and impact of library and informational service on patient care.

Methods

Multiple methods were used including focus groups of librarians for planning purposes: web-based survey of physicians, residents, and nurses and 24 follow-up, semi-structured interviews. Two primary research questions in the current study asked:

  • Whether information resources used were perceived as valuable by physicians, residents, and nurses,
  • Whether the obtained information was considered to have had an impact on patient care.

 

 Survey

 Survey respondents were asked five key questions to determine the relevance and value of print and electronic resources used. These include:

  1. The respondent’s profession and the types of work their position entailed;
  2. Think of a circumstance (within the last six months) you were looking for patient care, not available  in the patient record, electronic medical record system, or lab results and answer survey questions based on that circumstance.
  3. Select a principal diagnosis of patient to related circumstance and select specific resources you used to answer the question.
  4. Answer questions about each information source used including methods used to access the resource where you conducted the search.
  5. Whether you found information needed and whether finding and using this information was time efficient in treating your patient.

Results

The 56 participating library sites served physicians, residents, and nurses in 118 hospitals in the NN/LM MAR regions (excluding New England) and 4 sites from Canada.

  • Approximately 172,463 of medical professionals served participated in the survey.
  • Overall, 16:122 responses represent response rate of 10%.
  • Response rate for physicians was 10%
  • Response rate for residents was 12%
  • Response rate for nurses was 7%

Response rates by library sites varied considerably:

  • 21 sites- Response rate-10% or less
  • 25 sites- Response rate-11%-20%
  • 10 sites-Response rate-21% or more

Responses related to Nature of Information Respondents provided with a list were asked,

  • “Which principal diagnosis of patient to whom your situation is related? (Select only one answer).”

Most common diagnoses were cancer and heart disease.

  •  “What type of information did you need to answer your question? (Select all that apply).”

Over half of respondents checked therapy (54%). Other responses selected were:

  • Diagnosis-(53%)
  • Drug information-(52%)
  • Clinical guidelines-(48%)
  • Patient Safety (23%)
  • Adverse effects (29%)
  • Clinical procedure (29%)

 

 Value and Impact

Variables organized around four themes:

  • Quality of Information
  • Cognitive value
  • Contribution to quality patient care
  • Time saved

The majority who rated information as relevant, accurate, and current suggesting that perceived quality of information was high.

Cognitive Value

 This area was also rated high as to whether the respondent’s memory, details, and facts confirmed their prior knowledge, beliefs, or provided new knowledge.

Contribution to Quality of Patient Care

Results were high including potential usefulness of information in the future,its clinical value, and of its resulting in a better informed clinical decision.

Information Time Saved

Overall, 85% responded that finding and having information saved time.

Information Resources Used

Four resources most frequently used included:

  • Online Journals (46%)
  • PubMed/MEDLINE (42%)
  • Up To Date (40%) Used and reviewed highly by residents
  • Online books (30%)

Information Needs Satisfied

  • 59% responded “completely” found needed information
  • 52% of nurses (only partially) found needed information due to time limitations
  • 64% of physicians found needed information
  • 63% of residents found needed information

Note: Due to time and space limitations, interview results will not be discussed in this article.

Professional Article-Advocating the promise of E-Health through Information Technology

Due to challenges of finding an article that is not peer-reviewed and containing informative and thorough data regarding medical professionals’ perceptions of medical resource value, I chose this article by Crystal Sharp who discusses the many technological contributions of international health colleagues and the benefits these emerging technologies provide medical professionals and their patients.

Note: These presentations took place at E-Health 2009, the Second ICST Conference on Electronic Health Care for the 21st Century held in Istanbul, Sept. 23-25, 2009 (www.electronic-health.org).

Due to space limitations, I will discuss two technologies that best assist physicians in their diagnosis and treatment of patients.

Crystal Sharp, an information specialist, states that information professionals “have the added responsibility to keep abreast of, be advocates for, and participate in promoting health information literacy, evidence-based care, and sound information management principles.” Eric van der Goot, European Union Joint Research Centre, introduced and presented MedISYS as an “open source real time automatic data-gathering and analysis tool for surveillance and epidemiology.”  “MedISYS covers 2,200 sources worldwide with a primary emphasis on Europe, and includes local, regional, national, and international coverage in many languages. While van der Goot was careful to emphasize that while MedISYS facilitates human media monitoring activities, he cautioned the audience that “it is not another Google; it is not a search engine.” One of MedISYS’ many benefits to medical professionals is its data presentation layer which “includes convenience links to machine translation programs, where available; a display of other MedISYS categories and of persons and organizations found in text; and a display of online English translations of Chinese and Arabic.” This is a useful and valuable technology for physicians who work with patients of diverse cultures and nationalities.

Another similar trending e-health technology  introduced in 2009 by Floriana Grasso, University of Liverpool, is the European research project, PIPS (Personalized Information Platform for Life and Health Services). PIPS “investigates the use of an e-health platform for an intervention aimed at promoting physical activities among diabetic patients. PIPS uses a “feedback-based support system for the improvement of personal performance in physical activity and relies on a pedometer for assessing the patient’s daily activity and on a motivational strategy to provide personalized support” similar to the FitBit being used today even among non-diabetic patients.  Although this is very useful and beneficial to diabetic patients, it is still an important practice for physicians to work with their patients in monitoring their fitness progress, regulate their medications and tracking weight loss to gain maximum benefit and long term health from this technology.

Comparison

While both articles covered useful and beneficial resources and technology for medical professionals and consumers, both sources covered this information in several different ways as shown in the SJSU tutorial on “Finding Scholarly, Peer-Reviewed Articles”.

The peer-reviewed article, “The value of library and information services in patient care: … was not only comprehensive and direct in meeting my academic information need, but was very specialized and written for researchers and professionals in the academic and medical fields.

Furthermore, even as I was able to comprehend the information and statistics provided, I needed to look up unfamiliar words in an online medical dictionary.

In contrast to this article, the professional article: Advancing the promise of E-Health through Information Technology, was written by professionals and practitioners in the health technology arena and written for professionals and practitioners in the field while still being comprehensible to the lay reader.

A final fact regarding content that I observed in the comparison of these articles is that the E-Technology article, while professional, cited Crystal Sharp as the contributing author, but did not provide references, bibliography or list of the presenters contributing to the article. The scholarly peer-reviewed article, however, not only contained references, but also tables with statistics depicting the information in percentages provided by the respondents.

References

Marshall, J. G., Sollenberger, J., Easterby-Gannett, S., Morgan, L. K., Klem, M. L., Cavanaugh, S. K., … & Hunter, S. (2013). The value of library and information services in patient care: results of a multisite study. Journal of the Medical Library Association: JMLA101(1), 38.

Sharp, C. (2010). Advancing the promise of e-health through information technology. Online34(2), 34-39.