Please confirm that you would like to log out of Medscape.
If you log out, you will be required to enter your username and password the next time you visit.
Log outCancel
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020
| Contributor Information
Swipe to advance
1 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
Physicians face many tough decisions involving ethical and moral quandaries as part of their daily jobs. These issues can be stressful and emotionally draining. Medscape conducted our first ethics survey in 2010, and in this year's report, it's clear that some opinions have shifted from a decade ago. In 2020, more than 5000 US physicians shared their perspectives about the pressing ethical issues they encounter.
2 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
Physicians still consider patient romances taboo but to a small degree have become somewhat more accepting of such relationships. More acceptance of doctor-patient relationships in 2020 may stem from relaxed boundaries within society. Some patients call their physicians by their first names, communicate with them by text, or are able to view their doctor's personal postings on social media.
"I have not done this. I think, however, there are some instances where such relationships can be healthy and beneficial for both parties. If a physician treats a patient for a cold at an urgent care center and then runs into them in a grocery store and discovers compatibility, is that a problem?" —Gastroenterologist
"Hell, no! That is inappropriate, illegal, and disgusting." —Cardiologist
3 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
Female physicians were less accepting of romantic relationships with patients than were male physicians. Among female doctors, 69% said "no" and 8% said "it depends." Among male doctors, 58% said "no" and 10% said "it depends."
"No. Never. Not ever. There are many fish in the sea. Romantic involvement with a patient shows poor self-control and reflects a lack of boundaries. Get some therapy before you end up on that road." —Psychiatrist
"Depends on the nature of the professional association. An anesthesiologist who provides brief care for an emergency procedure and years later meets the patient again is a completely different deal." —Anesthesiologist
4 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
Although most parents vaccinate their children today, an increasing number are opting out of recommended immunizations, according to the Centers for Disease Control and Prevention (CDC). Male physicians (61%) were more accepting of treating unvaccinated children and adults than were female physicians (53%). Hospital-based physicians (64%) were also more likely to say "yes" to this question compared with office-based physicians (56%).
"It is very common in our rural Maine community. We work with those families and try to adjust the vaccine schedule or accommodate their complete refusal." —Family physician
"If allowed, I would restrict such people from my practice. Freedom to choose to not vaccinate is an artificial freedom because that lack of vaccination puts others at risk with many communicable diseases." —Internist
5 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
Doctors listed a range of factors that should be used to determine reopenings, including the local infection rate, safety precautions, and filtration ability. (Respondents could choose more than one answer.)
"Personally, I'd wait until a vaccine is available. But if schools/school systems have good plans in place and have thought about all potential issues as well as contingent plans should an outbreak occur, then it might be feasible." —Internist
"Children, who are at the lowest risk, need the social aspect of school as much as educational aspects. They also need immunologic exposures. College kids can do distance learning." —Neurosurgeon
6 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
Masking has become a subject of heated debate in recent months. A survey by the CDC found that 60% of people say they always wear a mask when in public, whereas 14% say they often wear a mask. However, 17% of respondents said they rarely or never wear a mask in public. A separate survey found that men were less likely to believe in the seriousness of the pandemic and more prone to view masks as a "sign of weakness."
"Wearing a mask primarily protects others. Not wearing a mask is selfish and inexcusable." —Pediatrician
7 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
The subject of politics has long been considered off-limits in certain company. Many physicians favor keeping it that way when it comes to patient discussions. However, male physicians were more open to the idea, with 22% saying "yes," 44% saying "no," and 35% saying "it depends." Among female physicians, 15% said "yes," 47% said "no," and 38% said "it depends."
"Politics, especially in today's volatile environment, has no place in the practice of medicine." —Preventive medicine physician
"Yes. I'm a human being and entitled to my opinions." —Urologist
"Cripes, it's bad enough as it is with your uncle at a Sunday dinner." —General surgeon
8 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
Economic upheaval triggered by the pandemic has caused a significant volume of the population to lose their jobs and in turn, their insurance. Although definitive data are not yet available, estimates put the rise in uninsured patients between 3 million and 8 million.
Three quarters of employed physicians said they would not limit Medicaid patients should the rate grow because of the virus. About half of office-based physicians agreed.
9 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
"I will continue to see my past patients regardless of their insurance or ability to pay, but I would not take any new patients on Medicaid." —Psychiatrist
"I have high overhead. I cannot survive on low payers." —Ophthalmologist
10 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
Younger physicians were more likely than their older counterparts to weed out patients. Among doctors younger than 45 years, 18% said "yes," 61% said "no," and 21% said "it depends." Among physicians aged 45 or older, 10% said "yes," 73% said "no," and 16% said "it depends."
"You shouldn't be able to cherry-pick patients. Spend the time and effort to optimize the care delivered to those with many comorbidities and/or overusers." —Internist
"It's natural to want to do that, and it is done already where I work." —Radiologist
"If I had the power to weed out people and it was necessary for the financial stability of the plan/practice, I would weed out smokers." —Emergency physician
11 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
Office-based physicians were more likely to answer "yes" (37%) to this question than were hospital-based physicians (30%). A decade ago, fewer doctors were accepting of the practice. Pressure to improve patient satisfaction scores and/or concern over online ratings are likely drivers behind the change.
"Some herbal medications are unproven and may not help in objective outcomes, but if a patient believes in their efficacy, they may be helpful." —Internist
12 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
Older physicians were somewhat more likely to give a hard thumbs- down to this question. Of doctors aged 45 or older, 67% said "no," 8% said "yes," and 26% said they'd rather not answer. Among doctors younger than 45 years, 61% said "no," 10% said "yes," and 29% would rather not answer.
"If there was no way for the patient to take the most effective treatment owing to cost (after exhausting all options), I would provide a prescription for the next most effective treatment. No treatment is effective if the patient cannot/does not take it." —Neurologist
"I would not wish to impoverish my patient because of providing an expensive therapy without adequate coverage. So it would depend." —Critical care physician
13 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
A decade ago, more physicians considered upcoding acceptable; 17% said "yes," 73% said "no," and 9% said "it depends." Stricter penalties for the practice may be one reason support has diminished. In recent years, the federal government has cracked down on doctors who upcode in violation of the federal False Claims Act. In 2019, the US Department of Justice obtained $2.6 billion in settlements and judgments from civil cases involving fraud and false claims in the health care industry.
"The codes are so often vague or inappropriate to the patient's true condition that accuracy is simply not possible. I have no problem approximating codes in the direction of higher acuity." —Neurosurgeon
"Never upcode for additional compensation, but I would embellish a prior authorization request if I felt the patient needed the test/treatment." —Emergency physician
14 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
Of male physicians, 59% said "yes," 12% said "no," and 29% said "it depends." Among female physicians, 47% said "yes," 16% said "no," and 37% said "it depends." Physicians answered this question similarly in 2010 and in 2020.
"If it's a deadly disease, then it would be your responsibility to do so; otherwise, it's up to the health department and the patient." —Family physician
"Depends on the severity of the disease." —Psychiatrist
"Yes, if the patient refuses treatment or engages in activities to spread the disease." —Ophthalmologist
15 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
One in 3 women and 1 in 4 men have experienced some form of physical violence by an intimate partner. Meanwhile, nearly 700,000 children are abused in the United States each year.
When it comes to reporting suspected abuse of patients to authorities, most physicians say they've never failed to report. Responses were similar in 2018, when 88% of doctors said "no," 12% said "yes," and 0% said "it depends."
16 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
Many factors and nuances influenced a physician's decision to report or not.
"Sometimes you are not sure and think you're overthinking it." —Physical medicine physician
"I have seen this a few times, especially in disabled patients. If it's a pattern, I would definitely report. First time, if the abuser also was well known to me, I would consider discussion and education with warning, if victim didn't want it reported." —Neurologist
"In my career, I'm certain I rationalized away signs and symptoms I suspected. But whenever I was told directly of such treatment, I reported it." —Endocrinologist
17 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
The use of telemedicine by physicians has widely increased in the past year, a trend rapidly accelerated by the COVID-19 pandemic. A 2020 survey by Merritt Hawkins found that 48% of physicians were using telehealth to treat patients, up from 18% in 2018. Younger physicians (70%) are more supportive than older physicians (60%) of using telemedicine to see patients without an initial in-person visit.
"It is ridiculous and accomplishes very little if you cannot see and examine the patient. It appears to be an unethical scheme to make money. It also creates a liability issue." —Internist
"Depends on the context. I do telemedicine and often see patients whom I don't know. I would not undertake a serious course of treatment without a visit." —Internist
18 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
Primary care physicians (59%) were somewhat more likely than specialists (52%) to say "no" to this question. Among primary care doctors, 11% said "yes," 21% said "it depends, " and 9% said they won't use telemedicine. Of specialists, 14% said "yes," 23% said "it depends," and 12% said they won't use telemedicine.
"There are access and other limitations to telemedicine. In some cases, telemedicine may be superior to face-to-face. Technologically challenged patients should continue to have access to in-person services. We need to find a good balance for integrating telemedicine with more traditional care models." —Preventive medicine physician
19 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
Office-based physicians (71%) were more likely than hospital-based physicians (60%) to say "yes" to this question. Of office-based doctors, another 17% said "no" and 12% said "it depends." Of hospital-based physicians, 26% said "no" and 14% said "it depends."
20 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
Office-based physicians (91%) answered "yes" to this question more often than hospital-based physicians (84%). Of office-based doctors, 2% said "no" and 7% said "it depends." Of hospital-based doctors, 3% said "no" and 14% said "it depends."
"I want the best for my patients. If a physician outside the system is clinically better with better outcomes that what is available in the system, then I refer to that physician. The system simply needs to up their game if they want me referring within the system." —Internist
"Only if the specialty or treatment was not available within my system. Gather the data and write the letter asking for an outside referral." —Orthopedic surgeon
21 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
Male physicians (54%) were more likely to answer "yes" to this question than were female physicians (43%). Another 27% of male physicians said "no" and 19% said "it depends." Of female physicians, 34% said "no" and 23% said "it depends."
"Because tobacco and other unhealthy behaviors are legal, the related medical expenses should be captured by taxes and other restrictions on these products. Weight loss is a more complex issue and in general, I'd be against added premiums." —Preventive medicine physician
22 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
Physicians 45 years or older gave this question a nod (29%) more often than younger physicians (16%). Overall, however, doctors today support unpaid charity slightly less than in 2018, when 34% answered "yes," 50% answered "no," and 16% said "it depends."
"As a PCP, I have already devoted countless consultations and treatments without pay. This is a charitable work build-in in my practice already." —Family physician
"Expected? No. Encouraged to do so? Yes. If I'm a physician and engaging in these things without people knowing, then I'm really doing it the right way. If expected, then all charity involvement now has to be published and removes opportunity for true humility." —Anesthesiologist
23 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
24 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
25 of 26
Scroll
Money, Patients, Romance: Physician Ethics 2020
Alicia Gallegos | December 11, 2020 | Contributor Information
Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide
More than 15,000 physicians told us how they feel about burnout and depression. In some cases, their responses differed along generational lines.Medscape Features Slideshow, Jan 2020
Commenting is limited to medical professionals. To comment please Log-in.
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Close
Contributor Information
Alicia Gallegos
Reporter, Medscape Business of Medicine
Close
References
Close
Image Zoom
Close
Feedback
Please do not use this form to submit personal or patient medical information or to report adverse drug events. You are encouraged to report adverse drug event information to the FDA.
Comments