Medscape physician survey reveals attitudes on anti-vaxxers, expensive treatment plans, other ethical dilemmas

A new physician survey on morals in medicine reveals attitudes on tricky situations with patients or money.

Medscape asked more than 4,100 U.S. physicians how they would react to some ethically challenging scenarios. Most respondents were male while a third were female, and most were older than 70 years old, followed by physicians in the 35-to-44 range. 

“Relationships with patients can become quite tricky,” the report read. “Sometimes a patient’s desires and the physician’s view of right or wrong may not align.” 

When asked whether they would treat a family who refused standard vaccines, most physicians (61%) responded they would, while a fifth said no and another fifth said it depends. This is similar to the breakdown in responses to the same question in Medscape’s 2020 report.

“I do think you have a duty to try to change their minds,” Arthur Caplan, Ph.D., a New York University professor of bioethics and Medscape contributor, said in the report. “If they still won’t get vaccinated, I would say you have an obligation to see them a few more times, but then it wouldn’t be unethical to give up.”  

Conversely, about half of doctors said they would not see patients who don’t mask or social distance. However, the report noted it is important for physicians to examine their motivation behind such a decision. If the goal is to protect the health of others, that is justified; it must not be because of judgment of that patient. 

Older physicians were more likely than those under 45 to insist on masking among patients, perhaps because they feel more vulnerable to danger because of their age. “I also think younger doctors may have a little more of a sense of respect for individual patient choice than older physicians,” Caplan said in the report.

Though treating patients with comorbidities is often more expensive, only 11% of respondents said they would cast aside patients with multiple conditions. There was little difference in responses from self-employed physicians and those working for health systems. Working toward a treatment plan is the “right choice,” Caplan said in the report. “You should try to help people deal with their health ailments.” However, he believes, weeding out does occur, especially in boutique practices that are responding to other patients who pay for speed. 

One in 10 doctors said they were willing to avoid telling a patient about a treatment because they know insurance would not reimburse for it. A third said it depends, while 60% said no. Physicians have a duty to make patients aware of their options, the report noted. At the same time, the vast majority of physicians (76%) agreed it is unacceptable to upcode or exaggerate a patient’s condition so a payer will cover it, a response that has been fairly steady for at least a decade. 

While in Medscape’s 2012 survey, 63% of physicians said they would breach confidentiality in a situation where someone’s health could be threatened, only half of doctors think so today.

However, a higher portion of physicians believe it depends on the circumstance compared to a decade ago. Caplan noted in the report that if someone faces a direct risk from catching a deadly disease, it is a physician’s duty to warn them, though it has to be serious and actionable in order to be justified.

Most physicians would also refer patients outside their health system despite business pressures. 

A higher portion of doctors this year (54%) agreed that patients with unhealthy habits, like smoking, should pay more for insurance compared to doctors surveyed in 2020 (50%). 

Among ethical issues that arise most often, physicians reported that honesty with billing can be an issue in a group where there is pressure to maximize productivity and that treatment decisions are often made without the input of patients with impaired decision-making.