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Medscape Internal Medicine Ethics Report 2020
Shelly Reese | January 29, 2021
| Contributor Information
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Medscape Internal Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Doctors routinely 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 internists had to say.
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Medscape Internal Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
The scarcity of personal protective equipment during COVID-19 has left internists feeling exposed and betrayed. More than half believe that physicians' should speak out publicly when they feel that their needs are not being met, but they often advised a measured approach. "It's an option, but not necessarily the first one," noted one. Many others agreed: "Everything has an order; you have to address your concerns with your institution first."
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Medscape Internal Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
More than three quarters of internists favor mandatory flu shots for physicians who have patient contact, unless there is a clear medical contraindication. "I think it's important to follow my own recommendations," noted one, while another simply called the question "a no-brainer."
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Medscape Internal Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
One in ten internists say they have failed on at least one occasion to report a suspected case of domestic abuse. That's down slightly from 2018 (14%). One internist said his supervisors were apathetic toward his concern. "I reported it to my superiors and asked for guidance, but it was not pursued." Another said he has met with resistance from victims themselves. "Most affected patients try to protect the perpetrator first for a long time."
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Medscape Internal Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
More than half of the internists surveyed believe that physician-assisted suicide/dying should be legalized. Opposition to the idea has declined from 37% in 2018. While "the difference in moral beliefs between the two sides is irreducible," says internist David Fleming, MD, president emeritus of the American College of Physicians and a member of the American Medical Association Council on Ethics and Judicial Affairs, "the search for common ground has led us to our shared respect for the patient."
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Medscape Internal Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
A third of internists now favor legalizing physician-assisted suicide/dying for patients with incurable suffering, up from 19% in 2018. Opposition has dropped from 56%. "Patient control over quality of life can be even more important than control over its quantity/duration," insisted one. The shift isn't surprising, says Fleming. "Physicians will naturally tend to move in that direction. The more physician-assisted suicide becomes legalized, the more it is going to become the default position." The result, he cautions, could lead to the marginalization of spiritual and psychological interventions.
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Medscape Internal Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Internists' attitudes toward the acceptability of romantic relationships with former patients have loosened considerably over the past 2 years. Three out of ten now believe that such a relationship is acceptable at least 6 months after the doctor-patient relationship has ended, up from 22% in 2018. "It's acceptable as long as there is no undue influence," Fleming says. "The important thing is that you don't mix the two."
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Medscape Internal Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Nine out of ten internists say they would report an impaired peer, but the vast majority would do so only after speaking to him or her about the problem first. "It is important to be sensitive to others with a substance abuse problem. The first step is to speak to a person about any suspected problem and proceed from there. Otherwise, the person will be alienated in getting help," noted one internist.
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Medscape Internal Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
More than 4 out of 10 internists object to the idea of random drug testing. Many say testing would only be acceptable if abuse is suspected. "If there is a concern, this may be reasonable. If there is no concern, this would be unreasonable," said one. Another said the nature of the physician's specialty should be considered. "I think this is more important for procedure-based physicians."
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Medscape Internal Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
The percentage of internists who unconditionally oppose upcoding fell from 79% in 2018, while the percentage that expressed ambivalence on the topic increased from 11%. Numerous internists said they would consider upcoding if it were in the interest of patient advocacy. Noted one respondent, "If the system is set up so that the only thing that would work for the patient's condition can be obtained by an upcode, then I would consider this."
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Medscape Internal Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Internists are less confident that they could remain impartial in their prescribing in the face of pharmaceutical company perks than they were 2 years ago. The percentage saying speaking fees and meals would not sway them fell from 66% in 2018. "The influences are subtle and take extreme measures to counteract," noted a retired physician who accepted speaking fees in the first few years of his practice. "I did observe the effects on prescribing."
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Medscape Internal Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
In light of an often polarizing political scene, the percentage of physicians overall who believe that it is okay to share their political beliefs with their patients declined from 23% in 2018 to 19% in 2020. But the trend among internists remained about the same (21% in 2018). Some say that political concerns have become part of the clinical encounter. "During COVID-19, and under the Trump administration, never before have so many discussions come up about the emotional stress and anxiety that patients are feeling," commented one internist.
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Medscape Internal Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
About three quarters of internists say they would not "weed out" patients with comorbidities or those who overuse resources to improve the bottom line under a capitated plan. "This is one of the fundamental problems with healthcare today," lamented one respondent. "Insurance companies should be insurance companies and take on the risk they are contracted to do. This is not — and should not be — the function of healthcare workers. It is a fundamental conflict of interest."
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Medscape Internal 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. Almost two thirds of internists say they would not limit Medicaid patients if many of their patients were forced to rely on the government program. "Long-time patients who are forced to go on Medicaid would still be seen," noted one, "but no new Medicaid patients. These are already restricted by practice."
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Medscape Internal Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
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Medscape Internal Medicine Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
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Medscape Internal 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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