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Medscape Neurology Ethics Report 2020
Shelly Reese | January 29, 2021
| Contributor Information
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Medscape Neurology 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 neurologists and neurosurgeons had to say.
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Medscape Neurology 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. Some neurologists lament that healthcare institutions see doctors as "replaceable cogs in a wheel" and believe that doctors should go public with their complaints. Others are more measured, insisting, as one responder noted, that going public should depend "on whether the resource is actually available to the organization."
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Medscape Neurology Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Nearly three quarters of neurologists and neurosurgeons favor mandatory flu shots for physicians who have patient contact. "The expectation should be there," said one neurosurgeon, allowing that physicians who have had allergic or autoimmune responses to vaccination in the past should be allowed waivers, "with the caveat that they self-quarantine with initial onset of symptoms."
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Medscape Neurology Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Roughly 9 out of 10 neurologists and neurosurgeons say they have always reported suspected cases of domestic abuse, while 8% admit that they have failed to do so, often when patients denied the abuse. Another 3% say they have waffled about such cases. "I have seen this a few times, especially in disabled patients," said one neurologist. "If it was a pattern, I would definitely report, but if it was the first time — if the abuser was also well known to me — I would consider discussion and education with a warning, if the victim didn't want it reported."
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Medscape Neurology Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Neurologists' and neurosurgeons' opposition to legalizing physician-assisted suicide/dying eased considerably over the past 2 years, perhaps reflecting the American Academy of Neurology's revised position statement. For 20 years the AAN formally opposed the practice, but in 2018, "with one in five US citizens and the neurologists who care for them" having lawful access to physician-assisted death, the AAN issued a new position statement. The statement leaves the decision of whether or not to practice legal physician-hastened death — the term preferred by the AAN — "to the conscientious judgement of its members acting on behalf of their patients."
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Medscape Neurology Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Neurologists' opposition to legalizing physician-assisted suicide/dying for patients with incurable suffering dropped from nearly half (48%) in 2018 to a third (33%) in 2020. James Bernat, MD, a Dartmouth emeritus professor of neurology and past chair of the AAN's Ethics, Law, and Humanities Committee, notes that the shift probably indicates that neurologists are aware that the practice is legal in some countries, including Canada. As they become more comfortable with physician-assisted suicide/dying in the context of terminal illness, respondents may be "gradually enlarging the context in which it might be acceptable," he says.
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Medscape Neurology Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
The percentage of neurologists and neurosurgeons who believe that a romantic relationship with a patient might be acceptable after the clinical relationship has ended increased from 6% in 2018 to 12% in 2020. At the same time, the ranks of those who categorically disavow the idea slipped from 74% to 64%. Bernat says the data may reflect that education and disciplinary actions have promoted awareness and given physicians a more nuanced understanding of boundary issues, although he cautions that "attitudes may have changed, but the risks haven't."
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Medscape Neurology Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Nearly 9 out of 10 neurologists and neurosurgeons say they would report an impaired peer, but the majority (63%) say they would do so only after first speaking to him or her about the problem. One respondent noted that it would depend on whether the colleague was impaired at work or in a social situation, while another objected to the idea that physicians should be held to a standard that is not applied to the general public. "Too often, hospitals and medical boards hand out harsh penalties that serve no purpose [other] than to ruin a person's career," he wrote.
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Medscape Neurology Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
About a third of neurologists and neurosurgeons endorse the idea of random drug testing. Many say that testing is not acceptable without cause. One neurologist insisted that if physicians are subject to random testing, then "attorneys, teachers, legislators, school bus drivers, and CEOs should be as well."
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Medscape Neurology Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Nearly a quarter of neurologists and neurosurgeons expressed ambivalence about upcoding. "I have thought about it multiple times," acknowledged one neurologist. "The prior authorization process is so broken." Another insisted that "the codes are so often vague or inappropriate. I have no problem approximating codes in the direction of higher acuity."
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Medscape Neurology Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
The percentage of neurologists and neurosurgeons saying that speaking fees and free meals would not sway their prescribing habits fell 11 percentage points from 2018, a decline that Bernat attributes to "the copious studies showing it does affect people's behavior. Saying that it doesn't is no longer a justified response." CMS's Open Payments database, which tracks payments made by drug and medial device companies to physicians, as well as healthcare institutions' increased vigilance about conflicts of interest, have likewise made doctors more sensitive to the topic, he says.
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Medscape Neurology Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
In light of an often polarizing political scene, the percentage of neurologists and neurosurgeons who believe that it is okay to share their political beliefs with their patients declined substantially in 2020. Many objected to the idea not on ethical grounds but because they felt that it would detract from the patient encounter. "Counterproductive," said one. "It is stupid to do so," wrote another.
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Medscape Neurology Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Neurologists and neurosurgeons were more likely than physicians as a whole (12%) to say that under a capitated or profit-sharing plan they would "weed out" patients with comorbidities or those who overuse resources to improve the bottom line. "Unfortunately you are almost forced to," wrote one, while another insisted that it would "depend on whether the reason for frequent use is legitimate or falsely perceived by a histrionic patient."
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Medscape Neurology Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Economic upheaval related to the pandemic has caused millions of people to lose their jobs as well as their employer-based health insurance. Most neurologists and neurosurgeons say they would not limit Medicaid patients if many of their patients were forced to rely on the government program. Some noted that they have no control regarding such decisions, while others used the question as a springboard to advocate for healthcare reform: "I have to admit that I don't want to starve. That's why we should have Medicare for all!"
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Medscape Neurology Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
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Medscape Neurology Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
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Medscape Neurology 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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