Family Physician Ethics Report – 2017

Doctor’s, in everyday practice, struggle with key ethical decisions related to everything from pain and death to money and romance.  Medscape’s Ethics Survey, 2017, saw more than 7500 physicians responding and sharing their views on the challenges they face ethically.  Given below is the synopsis of the responses by the family physicians, to the various questions asked during the survey.

Family Physician Ethics Report 2017 04-12-17 KP

Should a mistake that would harm a patient be ever covered up or avoid being revealed by a physician?  Is it an acceptable practice?

About a quarter i.e., 24% of family physician’s responded saying it is or might be acceptable to hide a harmful mistake; a response which in 2014 stood at just 9% answering the same.  However, most of the family physicians considered being “honest” and “forthright” in revealing their mistake to all the parties.  A large number did also say it would depend on the situation and the consequences.

Should the annual flu shots be made mandatory for the doctors?

Family physicians are not quite fervid to the notion of mandatory flu shots for physicians; in similarity to the profession altogether (63% v/s 67%).  While a lot of them got infuriated with this “required flu shot” notion; most of them also thought it to be a good idea – if they expect their patients to undergo immunization, they must lead and set an example for them first.

Should Physician-assisted suicide/dying be made for critically ill patients?

There are extremely mixed opinions from the family physicians concerning physician-assisted suicide and they are also less in favor of this practice than doctors in general (47% v/s 57%).  One of the physicians wrote that “Physicians should not be put in the position of hastening death.  This flies in the face of the Hippocratic Oath.   Individuals can commit suicide without the help of a physician.  To use the physician for the provision of a medical benediction diminishes our profession.”   To which another physician countered by adding, “We are far more humane to the pets who share our homes than we are with ourselves.”

Would you ever deny information to a competent patient on family’s request?

When asked in 2014, most of the physicians had responded saying that depending on the situation they might deny the information to the patients; however, that is not the scenario anymore.  The percentage of family physicians who refused to withhold the information from the patient has almost doubled in 2016 i.e., 78%, compared to 39% in 2014.  One of the physicians wrote that “Family members are not my patients. My obligation is only to the patient.”  Another physician wrote saying “Absolutely freaking NOT. I was fired once for doing this exact thing.”

Have you ever failed to report or further investigate a patient whom you had suspected to be a victim of domestic abuse?

18% of family physicians out of the total surveyed, responded saying that they have suspected a patient to be a victim of domestic violence, but failed to report it or further investigate, compared to 12% general physicians who said the same.  One of the physicians protested saying, “Adult women who will not leave their abuser, are at increased risk for death, if we involve law enforcement” to which another supported, claiming that a patient admitted to abuse, but asked the physician not to report it because the patient’s experience with the previous investigation was negative.

Is it ever appropriate to get involved with a patient in a romantic or sexual relationship?

While 70% of physicians generally say that doctor-patient romance is forbidden, 65% of family physicians find the relationship appropriate.  One of the family physician says that it depends on the kind of physician and the type of relationship they share with the patient, to which many contended, noting that such relationships are never acceptable for a psychiatrist.  Some said that it would be okay for a physician practicing in a remote area, on which one of the physicians wrote, “I have worked in rural Maine for 38 years.  I expect that 30% of my patients are also my friends.  I think it is permissible for health providers to become romantically involved with past patients.”

Would you report a colleague who sometimes seemed under the influence of drugs, alcohol or illness?

The vast majority of family physicians (78%) said that they would report an enfeebled colleague, and the percentage is growing.  Many asserted saying they would first warn the friend/colleague of what they are going to do.  Several reported that they have reported before and the end result has been favorable for the colleague—”they got help and are back practicing”— stating that reporting on a colleague “is not fun.”

Would you tell a patient of your ineptness in a particular procedure before you perform it?

50% of the family physicians said that they would accept and tell the patient of their ineptness for a procedure, while some added that they would refer the patient to another physician.  Others, having revealed their inexperience, stressed that they wouldn’t do the procedure if they are not qualified for it.

Should physicians be randomly tested for drug and alcohol abuse?

Family physicians exhibited mixed responses towards the idea of random testing for drug and alcohol abuse, and their viewpoint hasn’t changed much over the span of two years.  Family physicians are almost equally divided over whether testing should be allowed (“absolutely”) or is unacceptable (“A positive ETOH or positive THC test does not distinguish between use and abuse and could lead to great harm.”) Besides 1 out of 5 said that it depends on (“if the problem has been identified or if they are in recovery, only then they should be subjected to the test”).



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