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These difficulties for doctors and patients raise questions about the ethical integrity of the informed consent process.
It has therefore been suggested that individuals are less likely to accept at face value what is being recommended by their doctor, creating difficulties for doctors, who are not used to having their professional judgment and integrity challenged [ 2].
Children's critical care settings are intensely emotional, and some parents may not wish to be approached about research when their child is critically ill. 4 Such challenges pose difficulties for doctors and nurses recruiting to clinical trials in ensuring that parental consent has been informed, the participation voluntary and the recruitment process adhered to ethical principles.
There has been an increase in competition in the private sector and this has created difficulties for doctors seeking to establish private practice: "The problem is there are many doctors and nobody regulates the entrance of more doctors" (Gynaecologist #6, private clinic).
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The difficulty for doctors is there is no consistency in how people respond to stressful life events.
Another difficulty for doctors is that the discussion usually takes place when CPR is being withdrawn as a treatment option.
This difficulty for doctors to commit to non-care and health promotion activities was confirmed by one interviewee.
Once AIDS became known as a "gay disease" there was particular difficulty for many doctors in different specialties to get other medical professionals to acknowledge that AIDS could be transmitted to people who were not gay, such as infants born from drug-using mothers, children and adults who had hemophilia (and later, their wives), Haitians, and people who had received blood transfusions.
2 Thus, the omission of stillbirths for almost the first century of British civil registration has arguably constituted a major difficulty for both doctors and statisticians.
This may be one explanation why we observed the same difficulty with progression for doctors of ethnic minority background who are known to have a higher failure rate with the Membership of the Royal College of General Practitioners MRCGPP) exam.
Just as prescribing practice presents difficulties for newly qualified doctors, improving the quality of prescribing education is proving problematic for educators.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com