There’s a new survey out that looks at how physicians feel about a variety of ethical issues related to treating patients and financial compensation. Medscape interviewed over 4,000 physicians across 29 different specialties from all over the U.S. as part of its report, “Right or Wrong in Medicine: Emotional Situations with Patients or Money.” Here are some of the biggest takeaways:
When it comes to having romantic relationships with patients, nearly 30% said it’s acceptable if it’s been at least six months since the patient stopped seeing the physician and 59% said it is unacceptable. Just 3% of respondents believe it is acceptable overall.
Researchers say the number of “no” responses has been declining in recent years. “Such a relationship is inappropriate while the professional relationship is active and even for some time afterward,” said Thomas May, 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 with the patient where there’s a sense of gratefulness or vulnerability that makes the patient unable to say no to a personal relationship.”
May said the six-month rule may not be long enough. “I’d think something like two years as a minimum. If I were your oncologist and helped save your life, it may never be appropriate.”
When it comes to treating patients with multiple comorbidities, 69% said they would not weed out these patients, about 19% said it depends on the situation, and 11% said they would. Patients with comorbidities often require complex treatment, which makes it more expensive, but physicians still seem willing to treat them.
“That’s the right choice,” said Arthur L. Caplan, professor of bioethics at New York University. “You should try to help people deal with health ailments. Look, a lot of doctors struggle with comorbidities themselves. I don’t like weeding out [patients] but I think it goes on, often in boutique practices that are responding to other patients who pay for speed.”
Around 54% of physicians believe patients with unhealthy habits, including those who smoke and refuse to lose weight, should pay more for health insurance. Doctors remain split on the issue of charging these patients more when they are already struggling with health issues.
“You pay more for auto insurance if you’re a bad driver. Modify or pay more. Period,” said one respondent.
“We have an obligation to support lifestyle changes, but this is impossible to accomplish,” said another.
“Why should the rest of us who are engaging in healthier lifestyles pay for those who drive up healthcare costs with unhealthy behaviors?” asked another.
“Access to healthcare should never be dependent on finances or compliance,” said a fourth person.
And 87% of doctors said they would refer a patient out of their network 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 explained. “If the patient is driving 100 miles to your appointments, and a new doctor who is qualified opens up five 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 practices’ qualifications and your own.”
Finally, the majority of respondents (69%) said they would refuse to give a note to a patient whom they believe is faking their condition. Around 13% said yes and 18% said it depends on the situation.
“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,” May added.