Medscape recently released its 2018 Ethics Report, entitled “Money, Romance, and Patients.” To create the report, Medscape surveyed more than 5,200 physicians in over 29 different specialties to find out how they feel about the key ethical issues they cope with in their individual practices.
The report deals with a variety of topics from sexual harassment and whether a hospital or practice should penalize the accused, to whether physicians who have patient contact should be required to get an annual flu shot (69% of those surveyed said yes), to whether they would refer a patient to a physician outside of their own health system despite pressure to refer patients within the system (86% said yes).
The report also asked physicians whether patients who engage in unhealthy behaviors or do not follow their treatment recommendations should pay more for their medical insurance – this question provided some interesting responses, with 57% of physicians saying yes they should, 23% saying no, and 19% saying it depends. Medscape noted that the percentage of physicians saying yes decreased since 2014, when 69% of those surveyed thought patients should have to pay more if they engage in unhealthy behaviors or do not follow treatment recommendations.
When asked if they would ever prescribe a placebo-type treatment to a patient who doesn’t require treatment but demands to receive something, physicians were conflicted. 42% of those surveyed said yes, 39% said no, and 19% said it depends. Those who expounded on their answer said things like, “I did occasionally when I was in private practice, and felt it was the right thing to do then. I am not employed by an organization that prohibits this practice,” “Patient education is key. Treat the underlying problem. I don’t think placebo-type treatment is the way to go,” and “Placebo therapy under the conditions noted above should be accepted practice, since placebo works in 30-35% of research studies of drug management.”
Another question with close responses was whether physicians should be subjected to random testing for drug and alcohol abuse – 39% said yes, 42% said no, and 19% said it depends. Medscape also broke the “yes” answers down by specialty – 39% of specialists said yes (the highest being endocrinology, where 52% of respondents said yes, followed by anesthesiology at 50%) and 38% of primary care physicians said yes.
When asked if they would ever deny or decline to provide a potentially more effective treatment to a patient because his or her insurer would not pay for it, physicians have not changed their answer much over time: in 2018, 69% of physicians said yes, compared to 68% in 2016 and 70% in 2014.
One answer that experienced a sharp drop over time was whether the physician would drop insurers that pay poorly, even if it meant some longtime patients would not be able to see them anymore: in 2010, 57% of respondents said yes, 55% said yes in 2014, and 38% said yes in 2016 and 2018 surveys.
One of the questions our readers may be most interested in is whether physicians could be a paid speaker at a pharmaceutical company dinner or whether they could accept lunches from drug representatives without it influencing their prescribing habits. Over the course of time, yes responses have fluctuated: they went from 72% in 2012 to 59% in 2014, and back up to 62% in 2016, and then 67% in 2018.
Lastly, when asked some of their toughest ethical dilemmas, physicians varied on their experiences: one responded, “not being able to give blood to a Jehovah’s Witness, who died and would have otherwise survived,” “a terminal, ventilated patient’s family refused to withdraw care because they were going to get some extra money if he lived until his birthday, 1 month away,” and “a terminal cancer patient wanted to go home and die in peace with no treatment. His children and grandchildren wanted everything to be done despite his wishes for comfort care.”
In sum, despite some believing that ethics issues should be black and white for physicians and others in the medical field, there are often grey areas that cannot be easily distinguished.