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Ethics in HTM: Part III – An Ethical Profession  



Before we consider the professional and ethical integrity required to navigate the evolving HTM landscape, and the challenges posed by technological developments, increasing specializations, and the truly transformative megatrends heralded by the early, intrusive, and impactful arrival of Artificial Intelligence (AI) in healthcare, it is worth pausing to consider the ethical commitment already prevalent in the field.  So, for this Blog, I will begin and end with an anecdote (again, from a student enrolled in the Ethics in HTM course at the College of Biomedical Equipment Technology). 


“When I started in August of 2019, we had a very structured schedule of work, say six to three-thirty.  We would get work orders from a specific part of the hospital and, if it wasn’t anything to do with medical devices, we would not touch it – we knew what we were allowed to do and what we were supposed to do.  But then Covid hit and, with so many people furloughed, we were doing maintenance work as well.  We were even setting up negative pressure rooms.  It was an extreme change because suddenly a Biomed, who was kind of ignored in the hospital, a person who came in and got out and you would never really see besides hearing ‘Your work order is done,’ was suddenly recognized as much more essential. And we would be on call for two weeks at a time, when we would have 16-to-18-hour days.  They said the CDC or FDA tried to make sure all healthcare workers received PPE, but there was a period of about six months where the BMETs would have to go into Covid rooms with nothing but a flimsy little homemade mask and some plastic bags.  And we were so essential.  Nurses would freak out if something didn’t work, and they wanted to find loopholes where, instead of having to call headquarters to put in a work order, they wanted our direct numbers so that they could call us directly.  So, it was a very big change from being an anonymous little part of the hospital to being seen as necessary as doctors and nurses.”


The Pandemic Context


This was shared in class a few weeks ago by an excellent and passionate learner and, no doubt, an excellent and passionate HTM professional with a long and valuable career ahead of her.  And it is an anecdote well worth sharing.  The topic was the Pandemic and ethical considerations of its short-term contingencies and the longer-term changes in healthcare it introduced or accelerated.  But, as all instructors should know, a tangential answer to responses you had anticipated from a devised prompt, especially one based on experience, can lead to a much more substantive engagement on the topic at hand. 


The Pandemic had a profound impact on the HTM industry, not least on the work of BMETs, as facilities faced an unprecedented demand for essential medical equipment with the rapid influx of patients requiring critical care.  As these professionals worked to ensure that devices like ventilators and infusion pumps were properly functioning and available round-the-clock, the urgent need for additional equipment challenged them to acquire, install, and maintain new devices in an arduously compact time frame.  Supply chain challenges and disruptions caused additional systemic stresses which tasked the field to adopt innovative strategies for sourcing equipment parts, troubleshooting, and repairing devices.  The contributions of BMETs and other HTM professionals in addressing these exigencies were invaluable.


As Walter Brisebois has correctly noted, “Biomedical Technicians/Technologists are indirect patient care providers,[1]but the Pandemic demonstrated how direct that indirect patient care provision can actually be.  That said, the recognition of the role of the BMET during the Pandemic, as evidenced by our student, also raises a couple of questions.  Is the awareness of the essential role played in patient care one that will last, or will it return to an essential but inconspicuous background?  And why does it take such a harsh light to be cast for such acknowledgement to be made? 


An Invaluable Role in Healthcare


A valuable study was published in 2022 by Human Resources for Health, in collaboration with the World Health Organization, evidencing the crucial role that BMETs play in ensuring the availability of, and access to, critical care infrastructure.  The findings are stark.  Despite broad recognition of the essential role medical equipment plays in the provision of quality healthcare, more than 50% of equipment in developing countries is non-functioning.  Unsurprisingly, perhaps, to U.S. professionals, BMETs are a large part of the solution.  In one country, the quantity of non-functional devices in hospitals without BMETs was double that of hospitals with BMETs in residence, with similar results across all departments, including General, Lab, and Operation Theater. 


The study was titled, “Effect of deploying biomedical technician[s] on the functionality of medical equipment in the government hospitals of rural Peru.”[2]  But few HTM professionals, if any, will have to go that far to point to examples of the invaluable role of BMETs or, in the alternative, readily available examples of the frustrations encountered in the study with “inappropriate referral systems for repair and a lack of spare parts [which] influence the availability, functionality, and utilization of equipment.”  The installation, maintenance, calibration, and repair of medical devices for maximum functionality, from simple blood pressure cuffs to MRI devices, are key contributors to the accuracy and effectiveness of patient diagnostics and the continuity of healthcare services – at least, when they are permitted under often restrictive contracts and other for-profit factors disguised as concerns for patient safety.  One could add to this, no doubt, the challenges of workforce shortages and the dearth of non-Pandemic general awareness of the role.


An Ethical Profession


The Pandemic highlighted the value of BMET expertise and the ethical integrity of many in the workforce, but it did not create that value or integrity.  Exemplars of excellence in implementing and maintaining this high standard of care are evident throughout the healthcare ecosystem on a daily basis.  And this is a broad field of indirect patient care indeed, extending – as Dustin Telford has admirably articulated in a series of LinkedIn posts[3] – throughout the “life saving corridors [of Bood Banks],” “inside the quiet intensity of the Oncology Radiation Therapy Room,” “in the tranquil setting of Geriatric Care Facilities,” and “in the colorful and hopeful world of Pediatric Play Therapy Rooms,” among other essential provinces of care.


There is much to ponder upon in our student’s comments – rising to the demand of a dramatically impacted work environment, her role, initially taken for granted, being suddenly recognized as vital, and the courage and integrity to achieve so much “with nothing but a flimsy little homemade mask and some plastic bags.” 


As we reflect upon ethics, however, the challenges the industry faces, the megatrends it will confront, and the relative merits or otherwise of an established Code of Ethics specific to HTM, there is another key takeaway.  As we reach out to our peers and establish a common understanding of best practices, we should also look towards the best practices within our organizations.  Leveraging the integrity of your personnel, involving them in ethical decision-making, and exemplifying their best practices, might be as valuable as any ethical directive.  

 

Jim Doran is Senior Business Compliance Officer at the College of Biomedical Equipment Technology. 

 


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