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Medscape Psychiatry Ethics Report 2020
Shelly Reese | January 29, 2021
| Contributor Information
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Medscape Psychiatry 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 psychiatrists had to say.
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Medscape Psychiatry Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
While the scarcity of personal protective equipment during COVID-19 has left many doctors feeling exposed and betrayed, many psychiatrists demurred about whether it was right to speak out against their organizations. Many insisted that they have to go through channels first. "Obviously, some effort to work within the system first is appropriate, but I am assuming that the question applies to situations where this has been tried but fruitlessly," said one psychiatrist. "No employer deserves their employees' loyalty to the point of sacrificing our First Amendment rights."
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Medscape Psychiatry Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Seven out of ten psychiatrists favor mandatory flu shots for physicians who have patient contact. "Are there physicians who do not want to get an annual flu shot?" asked one, but a minority of psychiatrists objected, with one calling the influenza vaccine "junk science" that is "much different than a real vaccine like MMR or polio."
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Medscape Psychiatry Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Nearly 1 in 5 psychiatrists say they have not or might not report a suspected case of domestic violence. Claire Zilber, MD, past chair of the Colorado Psychiatric Society's ethics committee, says, "'Failed to report' is very different from 'failed to investigate.' 'Failed to investigate' means I blew you off and did nothing." Psychiatrists work with patients to address the issues surrounding the abuse, but state mandates for reporting domestic abuse vary. For example, Colorado, where Zilber practices, mandates reporting child and elder abuse. However, to report an incidence of adult abuse without the patient's consent would constitute a breach of confidentiality.
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Medscape Psychiatry Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
More than half of the psychiatrists surveyed believe that physician-assisted suicide/dying should be legalized, although a small percentage backed away from a resolute "yes" in 2018 (58%) to a more nuanced "it depends" in 2020. While advocates supported the practice in the name of patient autonomy, others voiced reservations. "This is a very complicated issue that I think no one-size-fits-all approach will suitably address," said one, while another insisted, "We already have physician-assisted dying; it's called hospice. Physician-assisted suicide? No, probably not."
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Medscape Psychiatry Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
A growing number of psychiatrists believe that the practice should be legalized for patients with incurable suffering. Support for the idea increased from 29% in 2018, while opposition declined from 44%. "Suffering is no way to live," said one psychiatrist, while another noted, "If they are suffering from a terrible progressive illness, such as ALS, I think it should be legal. Right now they must travel to another country for that. They should be able to die at home."
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Medscape Psychiatry Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Psychiatrists, whose specialty pointedly prohibits romantic involvement with patients, were more opposed to the idea of dating patients or former patients than were doctors overall, even 6 months after the patient stopped being their patient. Said one respondent, "This of course is a blatant NO in the fields of psychiatry and psychology. In other disciplines, however, it may be acceptable only if the professional doctor-patient relationship is completely severed. A waiting period of at least 1 year should be the rule."
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Medscape Psychiatry Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Most psychiatrists say they would report an impaired peer but insist that they would do so only after speaking to him or her about the problem. "This is an all-too-common scenario that I have personally been involved in several times," said one psychiatrist, noting that "it's best to approach the allegedly impaired professional first. This avoids a negative confrontation and spares the person in question from feeling shamed or accused. This allows the impaired professional to think more rationally and usually results in him or her agreeing to go into treatment."
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Medscape Psychiatry Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
In 2018, psychiatrists were equally divided about random testing for drug and alcohol abuse, but in 2020 more psychiatrists opposed the idea. "History and behavior are relevant parameters" for testing, insisted many. "Frankly, whatever anyone uses outside of work has little relevance to work performance," argued another. Random testing was likened by one respondent to "a can of worms" that "could potentially harm physicians who use substances in a way that does not impact their performance in job duties more than it would prevent harm to patients."
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Medscape Psychiatry Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
More than a quarter of psychiatrists would or might overstate or upcode a patient's condition, compared with 22% of physicians overall. "Hospitals are not paid to care for personality disorder," said one respondent. "To stay open, they have to bill for mood disorders instead. The real lack of ethics lies with insurers who refuse payment based on the diagnosis rather than on the medical necessity of hospitalization." Another confessed to "a bit of slippage in my usually highly moral system...since I think the claims process is often immoral." A third said he does not upcode but instead inundates a payor with information. "In my experience, giving 'overinformation' is usually enough to convince the reviewer, usually out of exhaustion, to authorize treatment."
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Medscape Psychiatry Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Psychiatrists were much more circumspect about their ability to remain impartial in their prescribing in the face of pharmaceutical company perks than they were 2 years ago: 4 out of 10 say meals and speaking fees could influence their prescribing behavior, an increase from 27% in 2018. Still, more than half of psychiatrists insisted that they could remain objective. "Do you buy every product you see advertised? Of course not," protested one.
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Medscape Psychiatry Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Psychiatrists are slightly more reticent to discuss politics with patients than are physicians in general, 19% of whom say political discourse is okay. "It is a matter of boundaries," said a hospital-based psychiatrist. "Conversations with patients should serve the patient and not just gratify the physician." Another voiced a similar perspective: "Keep it to yourself. You are there for the patient. Your political and religious beliefs need not apply unless you are being asked to do something that violates your values."
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Medscape Psychiatry Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
A number of psychiatrists noted that they don't participate in capitated or profit-sharing arrangements but criticized systems that would create a financial disincentive to care for complex or demanding patients. "Behaviors are changed by these types of requirements, same as when entertaining drug reps. Which is why I would avoid such a system," said one. Another noted, "I don't have these constraints, but I think this is a grave risk and a terrible idea. Never trust your dog to guard your sandwich."
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Medscape Psychiatry Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
Economic upheaval caused by the pandemic has resulted in millions of people losing their jobs as well as their employer-sponsored health insurance. Psychiatrists were more likely than physicians as a whole (22%) to say they would limit their panel of Medicaid patients. Many in private practice wrote that they do not accept Medicaid or, in some cases, any type of insurance at all.
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Medscape Psychiatry Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
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Medscape Psychiatry Ethics Report 2020
Shelly Reese | January 29, 2021 | Contributor Information
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Medscape Psychiatry 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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