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
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022
| Contributor Information
Swipe to advance
1 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
Relationships with patients can become quite tricky. Sometimes a patient's desires and the physician's view of right or wrong may not align. Other times, money issues — on either the patient's or the physician's part — may require a difficult decision. And sometimes there's no right or wrong, just a choice about the best option.
Medscape asked US physicians how they would respond to ethically challenging scenarios involving patient interactions, both professional and personal. More than 4100 doctors revealed what they would do and explained their reasons.
(Note: Some chart data in this presentation do not add up to 100% because of rounding.)
2 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
Physician responses to this scenario are similar to those expressed in our 2020 report. But "no" responses have declined somewhat in the 10 years since our 2012 report (68%), and the share of doctors willing to start dating after 6 months has risen slightly (from 22%).
"Such a relationship is inappropriate while the professional relationship is active and even for some time afterward," says Thomas May, PhD, a bioethicist at Washington State University. "There's a professional dynamic that needs to be maintained, a sense of objectivity. Plus, the physician is in a power relationship to the patient where there's a sense of gratefulness or vulnerability that makes the patient unable to say no to a personal relationship.
"I'm not sure 6 months after they stop being your patient is long enough. I'd think something like 2 years as a minimum. If I were your oncologist and helped save your life, it may never be appropriate."
3 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
Male physicians are somewhat more willing to start dating a patient once some time has passed after treatment. Female doctors are somewhat likelier to say no to romantic relationships under any circumstances.
4 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
Physician responses to this question were about the same as in our 2020 report (58% yes, 20% no, 22% it depends), published in the height of the COVID-19 pandemic. A solid majority of doctors felt justified in declining to treat vaccine-refusers.
It's not always easy to stick with that position. Some pediatricians have wavered and agreed to see unvaccinated families after normal hours in a mostly empty office, says Arthur L. Caplan, PhD, a New York University professor of bioethics and frequent Medscape contributor.
"I do think you have a duty to try to change their minds," he adds. "If they still won't get vaccinated, I would say you have an obligation to see them a few more times, but then it wouldn't be unethical to give up."
5 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
6 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
Half of physicians felt that it's appropriate to refuse treatment if a patient won't take such steps to prevent COVID transmission. But before setting a personal or medical practice rule, it's important for physicians to examine their primary motivation, May believes. Is the goal to protect the patient's own health and that of other patients, physicians, and staff? "Your refusal to treat might well be justifiable there," he says.
"At the same time, we have very strong professional obligations where it is not appropriate to refuse to provide care just because you judge that patient as reckless and therefore undeserving."
7 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
Older doctors were somewhat likelier than their peers under age 45 to insist that masks be worn or social distance be maintained by patients and their families.
"Older doctors may feel more vulnerable to danger just because of their age," Caplan observers. "I also think younger doctors may have a little more of a sense of respect for individual patient choice than older physicians," who sometimes may be "more paternalistic."
8 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
9 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
As many physicians have noted, patients with comorbidities often require frequent and complex treatment, which makes treatment more expensive. Still, very few physicians were willing to cast aside patients with multiple diseases or conditions. Most preferred to keep working toward a treatment plan.
"That's the right choice. You should try to help people deal with their health ailments," Caplan says. "Look, a lot of doctors struggle with comorbidities themselves. I don't like weeding out but I think it goes on, often in boutique practices that are responding to other patients who pay for speed."
10 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
One might assume that self-employed physicians have a greater self-interest to keep patient count high, or that those working for health systems do as well because they answer to administrators. But responses of self-employed doctors were not that different from those of employed physicians.
11 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
Very few doctors were willing to avoid telling a patient about a treatment just because they know health insurance won't pay for it.
It's unethical to presume "what that patient knows, wants, or has access to," May says. "We have a duty to at least make our patients aware of the options and allow them to judge whether they can afford these options. It's really a deeper form of informed consent."
12 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
These results have been fairly steady for at least a decade. In our 2012 report, 75% of physicians said no, 13% said yes, and 12% said it depends.
Many doctors are willing to stretch coding policies to the limit to support patients and their finances, Caplan says. "That's acceptable advocacy. But most doctors will not say they are willing to commit fraud."
13 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
Attitudes toward patient confidentiality have changed somewhat in the past decade. In our 2012 report, 63% of physicians said it's okay to breach confidentiality while 23% said it depends. It's worth noting that communicable diseases vary in severity, Caplan says.
"I teach that if you know someone faces a direct risk from catching a deadly disease, and you know who that person is, then you have a duty to warn," he says. "The disease has to be serious for [breaching confidentiality] to be morally defensible, and your disclosure has to be actionable. Telling your mother won't achieve a lot" in protecting someone's health.
14 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
15 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
Bioethicist May expects responses to this question (which were about the same as in our 2020 report) to show that both male and female physicians strongly support reporting of abuse cases.
"It reflects the tremendous strides society has made in recognizing the impact of abuse and the need for required-reporting policies, because victims are often, if not usually, reticent to come forward," he says. "Required reporting is necessary and in the patient's interests."
16 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
As in our 2020 report, when 87% of doctors answered yes, the great majority were willing to suggest that a patient go to another office or hospital if their treatment could benefit.
"Morally, you always have to tell patients their options, even if you don't want them to go to another practice," Caplan says. "If the patient is driving 100 miles to your appointments, and a new doctor who is qualified opens up 5 minutes from their house, they should know.
"That doesn't mean you can't try hard to keep the patient by telling them all about your practice's qualifications and your own."
17 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
Doctors don't set health insurance rates, of course. But a slightly higher majority than in our 2020 report (50%) said it's right that people who smoke, won't try to lose weight, etc., should pay higher premiums to help cover their treatment costs.
18 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
19 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
May thinks most doctors are fine with the idea that society expects active charity work based on their profession, but some balk at mandated volunteer hours.
"Most physicians see helping fellow man as an important reason for their career path," he notes. "On the other hand … we're seeing a healthcare workforce shortage and burnout at levels we haven't seen in decades. The idea of their providing even more of their time and labor can be daunting."
20 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
21 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
There are excellent justifications for the nearly 7 in 10 doctors who refuse to give a note to a patient whom they believe is faking an emotional need, May posits.
"It's much like handicapped placards; if we give them out to too many people, then handicapped spaces become unavailable to those who need them. Issuance of these types of permissions should be restricted to those who actually need them for a legitimate medical reason."
22 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
23 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
24 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
25 of 26
Scroll
Right or Wrong in Medicine: Emotional Situations With Patients or Money
Jon McKenna | December 7, 2022 | Contributor Information
Right and Wrong in Medicine: Life, Death, and Wrenching Choices
Physicians reveal how they would respond to difficult decisions and scenarios involving medical care and personal treatment of patients, sharing both their insight and turmoil.
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
Jon McKenna
Senior Editor, Reports
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