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Medscape Family Medicine Ethics Report 2020
Shelly Reese | January 29, 2021
| Contributor Information
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Medscape Family Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Every day, doctors wrestle with ethical decisions involving everything from pain and death to money and romance. In 2020, as the COVID-19 pandemic created a shortage of personal protective equipment and caused many people to lose their jobs and their employer-sponsored health insurance, doctors faced an array of new ethical questions. Medscape surveyed more than 5000 physicians about the ethical challenges they face. Here's what family physicians had to say.
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Medscape Family Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
The scarcity of personal protective equipment during COVID-19 has left many physicians feeling exposed and betrayed. More than half of family physicians defended physicians' right to speak out publicly. "This is the only way that physicians can effect change," insisted one. Many others ventured that it was best to first work within the organization to make a difference, while some expressed concern about the potential repercussions of speaking out publicly.
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Medscape Family Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Nearly three quarters (72%) of physicians overall favor mandatory flu shots for doctors who have patient contact. Family physicians were less enthusiastic about the idea. Some objected that mandatory vaccination violates "freedom of choice," while others pointed to the vaccines not being 100% effective: "Why require an invasive procedure that is not guaranteed to work?"
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Medscape Family Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
The percentage of family physicians who say they have failed to report a suspected case of domestic abuse decreased from 18% in 2018 but remains higher than the rate for physicians overall (10%). Some family doctors say they haven't filed a report because they were not confident about their suspicions. Others said their states do not require reporting. One respondent's comment represented another take on the matter: "If I have asked the appropriate questions and the person is not forthcoming with information, I have dropped the subject."
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Medscape Family Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Family physicians' support for physician-assisted suicide/dying for terminally ill patients plateaued in 2020. Although some family physicians objected on religious or moral grounds and others argued that doctors should not be involved in the suicide/dying process, advocates insisted on patients being in control. Wrote one respondent, "Terminally ill people should have the right to go out on their own timing, comfortably."
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Medscape Family Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
More than a third of family physicians now favor physician-assisted suicide/dying for patients with incurable suffering — up from 1 in 4 in 2018 — while opposition dropped ten percentage points. Family physicians espoused the idea of a patient's right to self-determination, but they repeatedly underscored that assisted suicide/dying could only be considered if "all options for mitigation of symptoms and suffering have been exhausted." One respondent suggested that a patient's suffering might stem not only from physical pain but from financial, social, or existential suffering, and that these issues would have to be explored before assisted suicide/dying could be considered.
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Medscape Family Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
About a third of family physicians believe that it is acceptable to become romantically involved with a patient if at least 6 months have passed since that person has stopped being your patient. The share disavowing the idea declined from 59% in 2018. Although attitudes are shifting, family physicians made it clear that they are cognizant of boundaries. Many echoed this sentiment: "Termination of the patient-physician relationship should be established before a romantic relationship is allowed to proceed."
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Medscape Family Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Nine out of ten family physicians say they would report an impaired peer, but the majority say they would do so only after first speaking to him or her about the problem. Several noted that their decision would depend on whether the individual was impaired at work or in a social situation. "Big difference if they are on vacation and drink too much so they need a ride home, versus being impaired at work or when on call," noted one.
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Medscape Family Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Family physicians are evenly divided on the topic of random drug testing. Those objecting say that testing should be confined to incidents where there is suspected abuse. "Freedoms being infringed, again. With probable cause, different story," insists one. Others say that if all healthcare workers in an institution are likewise subjected to mandatory testing then they would not object, but doctors shouldn't be singled out.
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Medscape Family Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
A decade ago, 17% of physicians surveyed believed that upcoding was acceptable. Today that share is down to 8% among physicians as a whole and family physicians in particular. Marc Tunzi, MD, a professor of family and community medicine at the University of California San Francisco, and a certified healthcare ethics consultant, attributes the shift to numerous factors, including a decline in self-employment and changes in coding that make it easier for doctors to check the right boxes. That said, numerous family physicians expressed frustration and anger about prior authorization, which "has proven itself, many times over, to be morally unacceptable. Violation is potentially acceptable for the patient's benefit medically," said one.
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Medscape Family Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Nearly 6 out of 10 family physicians say they could accept meals and speaking fees from pharmaceutical companies without it compromising their objectivity. That's somewhat down from 2018, when 61% said they could do so. One doctor said that he believed he could remain unbiased, but "the overwhelming consensus of organized medicine says that I cannot, so I defer to the collective wisdom of the group." Tunzi says, "People who say that they can maintain their impartiality are wrong. They're just wrong."
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Medscape Family Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
In light of an often polarizing political scene, the share of physicians who believe that it is acceptable to discuss their political beliefs with their patients declined in 2020. That was especially true among family physicians. Fewer than 1 in 4 family physicians say it's acceptable, down from 31% in 2018. The only exception, according to one respondent, was "if the patient knows you from church/school/outside contacts and they initiate the discussion."
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Medscape Family Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
About two thirds of family physicians say they would not "weed out" patients with comorbidities (or those who overuse resources) to improve the bottom line under a capitated plan, but some admit that noncompliant patients can make the idea awfully tempting. "I was aqhast that I actually had that thought today about one of my persistently noncompliant diabetic patients," said one respondent.
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Medscape Family Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Economic upheaval caused by the pandemic has caused millions of people to lose their jobs as well as their employer-based health insurance. More than half of family physicians insisted that they would not limit Medicaid patients if many of their patients were forced to rely on the government program. "Same people? Let them continue to come back. They are known to me," said one. But many employed physicians say the decision is out of their hands.
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Medscape Family Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
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Medscape Family Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
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Medscape Family Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
"Death by 1000 Cuts": Medscape National Physician Burnout & Suicide Report 2021
Burnout and depression are still serious problems among physicians, especially amid COVID-19. More than 12,000 physicians told us how burnout has affected their relationships, career, and happiness.Medscape Features Slideshow, Jan 2021
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Shelly Reese
Freelance writer
Cincinnati, Ohio
Disclosure: Shelly Reese has disclosed no relevant financial relationships.
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