Today's physicians face more ethical dilemmas than ever--from assisted suicide to abortion to what insurance they accept. And there is wide variation among physicians about how they would respond to each scenario, according to a new survey of 24,000 physicians from Medscape and WebMD.
"The increasing number of conflicting forces makes ethical decisions tougher and more wrenching for physicians," Leslie Kane, executive editor of Medscape Business of Medicine, said in a statement. "Technological advances, new regulations and more pressure to control costs all fight with the doctors' desire to give patients the best possible care. Some ethical issues are life-and-death struggles, and doctors take them strongly to heart."
Physicians self reported on a variety of issues.
Insurance: When asked if insurers should be dropped if they do not pay well, even if longtime patients must stop seeing them, 27 percent of physicians surveyed responded "yes," 41 percent said "no," and 33 percent said "it depends." Among "yes" respondents, one physician said, "When I lose money seeing patients and I can't pay my staff, I have little choice."
Prescribing: When asked if they would undertreat a patient's pain out of fear the person would become addicted to medications, 15 percent of doctors said "yes," while 65 percent said "no," and 20 percent said "it depends." Among the "yes" respondents, one physician said, "I fear the prosecutor more than I fear the patient complaints."
Informing on peers: When asked if they would inform a patient who was scheduled to have a procedure done by another physician they thought was substandard, 47 percent said "yes." Only 16 percent said "no," and 37 percent said "it depends." One survey participant told Medscape, "Everyone has varying skill. If the physician is board certified is all that matters. I might recommend a second opinion."
Defensive medicine: When asked if it is acceptable to perform "unnecessary" procedures defensively because of malpractice concerns, 23 percent of physicians responded "yes." Half (55 percent) said "no," and 22 percent said "it depends." These results are consistent with an earlier study of cardiologists in which 24 percent admitted they'd order potentially unnecessary tests out of fear of a malpractice suit.
Error reporting: When asked if physicians should always admit to mistakes, even if the mistake caused no harm, most doctors (63 percent) said "yes." However, 16 percent said "no," and 21 percent said "it depends." Among "no" respondents, one doctor said, "Something like giving the wrong drug--even if no harm results--is worth reporting for continued quality improvement."