title: Ethics takes time, but not that long.
abstract: BACKGROUND
  Time and communication are important aspects of the medical consultation. Physician behavior in real-life pediatric consultations in relation to ethical practice, such as informed consent (provision of information, understanding), respect for integrity and patient autonomy (decision-making), has not been subjected to thorough empirical investigation. Such investigations are important tools in developing sound ethical praxis.
  
  
  METHODS
  21 consultations for inguinal hernia were video recorded and observers independently assessed global impressions of provision of information, understanding, respect for integrity, and participation in decision making. The consultations were analyzed for the occurrence of specific physician verbal and nonverbal behaviors and length of time in minutes.
  
  
  RESULTS
  All of the consultations took less than 20 minutes, the majority consisting of 10 minutes or less. Despite this narrow time frame, we found strong and consistent association between increasing time and higher ratings on all components of ethical practice: information, (beta = .43), understanding (beta = .52), respect for integrity (beta = .60), and decision making (beta = .43). Positive nonverbal behaviors by physicians during the consultation were associated particularly with respect for integrity (beta =.36). Positive behaviors by physicians during the physical examination were related to respect for children's integrity.
  
  
  CONCLUSIONS
  Time was of essence for the ethical encounter. Further, verbal and nonverbal positive behaviors by the physicians also contributed to higher ratings of ethical aspects. These results can help to improve quality of ethical practice in pediatric settings and are of relevance for teaching and policy makers.
authors.affiliation: Centre for Bioethics at Karolinska Institutet and Uppsala University, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. Mats.Hansson@bioethics.uu.se
authors.forename: Mats G
authors.initials: MG
authors.lastname: Hansson
authors.forename: Ulrik
authors.initials: U
authors.lastname: Kihlbom
authors.forename: Torsten
authors.initials: T
authors.lastname: Tuvemo
authors.forename: Leif A
authors.initials: LA
authors.lastname: Olsen
authors.forename: Alina
authors.initials: A
authors.lastname: Rodriguez
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D032882:Comprehension; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009633:Nonverbal Communication; D010044:Outpatient Clinics, Hospital; D010372:Pediatrics / Q000193:education / Q000941:ethics* / Q000379:methods; D010808:Physical Examination / Q000941:ethics; D010817:Physician-Patient Relations / Q000941:ethics*; D011368:Professional-Family Relations / Q000941:ethics*; D012017:Referral and Consultation / Q000941:ethics*; D013548:Sweden; D013997:Time Factors; D014741:Video Recording