More Physicians Willing to Hide Mistakes, Survey Reveals

December 01, 2016

Seven percent of physicians say it's acceptable to hide a clinical mistake that harms a patient, while another 14% leave the door open, saying "It depends," according to the Medscape Ethics Report 2016.

True, a clear majority of surveyed physicians — 78% — told Medscape that it is never okay to cover up or avoid revealing such an error. However, the percentage who answered that way is down from 91% in 2014 and almost 95% in 2010.

The greater willingness of physicians to hide mistakes runs counter to a trend among hospitals to fess up. A number of hospitals in recent years have begun to voluntarily report medical mishaps to patients, apologize for them, and offer compensation in an effort to keep malpractice out of the court system. Some states have passed so-called "disclose, apologize, and offer" laws to give clinicians a process for settling with injured patients. At Johns Hopkins University School of Medicine, students learn how to disclose adverse events through role-playing exercises.

Arthur Caplan, PhD, a bioethicist at NYU Langone Medical Center, said the increase in the percentage of physicians who'd hide a mistake with harmful consequences is "surprising and disturbing," especially when other sectors of the healthcare world are striving for greater transparency.

"This is a finding that makes me nervous," Dr Caplan told Medscape. "The shift is in the wrong direction."

Some physicians who answered "It depends" to the cover-up question have questions of their own, such as "How much harm was done?" One urologist was flat-out honest about dishonesty, saying, "What doctor wants to self-incriminate?"

The Code of Medical Ethics of the American Medical Association doesn't leave any wiggle room on the subject, however. It calls on physicians to "disclose medical errors if they have occurred in the patient's care, in keeping with ethics guidance."

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Medscape's 2016 ethics survey uncovered other changes in professional attitudes.

Forty-five percent of physicians said they would prescribe a placebo for a patient who didn't require treatment but demanded something anyway, almost double the percentage in Medscape's 2010 ethics survey. The percentage of physicians answering "It depends" remained about the same ― 17% in 2016 compared with 18.2% in 2010.

Many physicians point a finger at patient-satisfaction questionnaires and physician-rating websites as sources of pressure to keep patients happy.

Is it ever acceptable for a physician to become romantically or sexually involved with a patient? Physician scruples about this are softening. The percentage of physicians saying "no" to such relationships decreased from 83% in 2010 to 70% in 2016. But it's not as if Do Not Disturb signs are hanging from exam-room doorknobs. Only 2% of physician said it was acceptable to have an amorous relationship with a current patient. For another 21%, such relationships were permissible only 6 months to a year after the patient had left the physician's practice. Yet another 7% percent said, "It depends."

The survey showed where physicians stood on a wide variety of ethical issues. For example:

  • Seventy-eight percent said they would not withhold treatments or tests to avoid penalties for exceeding their organization's patient-care budget.

  • Physicians were evenly split on whether they should be randomly tested for drug and alcohol abuse — 41% for, and 42% against.

  • Twenty-five percent of physicians said they should not be required to get flu shots, with some championing freedom of choice.

  • Fifty-one percent said they would caution a patient from having a procedure performed by a colleague of questionable ability. Fifteen percent said no, and 34% fell back on "It depends."

  • Thirty-eight percent said they would drop a poorly paying insurer even at the cost of losing some long-time patients with that coverage. That's down from 57% in 2010. However, the percentage of physicians in the murky "It depends" camp has grown from 17% to 26%.

  • Sixty-two percent said their prescribing habits wouldn't be influenced if they received a speaking fee or free lunches from a pharmaceutical company. A recent study published in JAMA Internal Medicine found otherwise.

The latest Medscape ethics survey was completed online by more than 7500 physicians — 63% of them female — in more than 25 specialties. Roughly one in four was an internal medicine or family medicine practitioner. Thirty percent worked in a hospital, while 40% worked in an office setting as a soloist or a member of a group practice.

The complete results of the 2016 ethics survey are available here.

Follow Robert Lowes on Twitter @LowesRobert


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