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November 19, 2012

One in three doctors: It may be OK to cover up some mistakes

Daily Briefing

End-of-life care requests, medical errors, and romantic relationships with patients present some of medicine's most complicated ethical dilemmas, according to a new survey of more than 24,000 U.S. physicians.

Medscape Medical News' 2012 Ethics Survey included physicians across more than 25 specialties on various ethical issues in medicine, including issues pertaining to life-and-death decisions, legal mandates, and romantic relationships with patients.

At issue: Medical errors

When asked whether it is acceptable "to cover up or avoid revealing a mistake if that mistake would not cause harm to the patient:"

  • 16% of respondents said "yes;"
  • 63% said "no;" and
  • 21% said "it depends."

One physician said, "If there's absolutely no adverse effect, why undermine the patient's confidence in my competence by discussing every minor mistake?" Another noted that "innocuous errors are unnecessary fodder for plaintiff attorneys and anxious patients."

However, one physician said that honesty "is the foundation of physician-patient relationships" and that doctors should "be honest at all costs." Moreover, one doctor notes that reporting errors that do not cause harm is worthwhile for "continued quality improvement."

At issue: Romantic relationships with patients

The survey asked patients whether it is "ever acceptable to become involved a romantic or sexual relationship with a patient" and found that:

  • 68% of survey participants said "no";
  • 22% said a relationship with a former patient is acceptable;
  • 9% said "it depends"; and
  • 1% said "yes," even if it is a current patient.

"I think it depends in part on the type of physician and medical care," one pediatrician said. "For example, I would be less concerned about an ophthalmologist getting involved with a patient who has had general yearly visits than I would an internist or oncologist."

At issue: End-of-life care

Physicians in the survey were divided on ethical dilemmas pertaining to end-of-life care. For example, when survey respondents were asked whether they would provide life-sustaining therapy that they believed to be futile:

  • 35% said "yes;"
  • 24% said "no;" and
  • 41% said "it depends."

One physician wrote "I've seen a patient recover after a prolonged comatose state post-cardiac resuscitation, which went on for 30 minutes; his therapy was thought to be futile." Another physician noted that they might discuss the care with the patient and "encourage them not to continue treatment."

When asked whether "physician-assisted suicides should be allowed in some situations:"

  • 47% of survey respondents said "yes;"
  • 40% said "no;" and
  • 13% said "it depends."

Expert: The future of medical ethics gets even more complicated

Ethics are only going to get more complicated as technology continues to advance, says Kenneth Prager, chair of the medical ethics committee at Columbia University Medical Center. "For example, do you do a CT on a patient whose brother died of lung cancer, but he is not considered to be in a high-risk category?" Prager asks.

Prager notes that few questions on the survey received unified responses. "This shows you that so much of what we deal with in medicine in complicated and nuanced," he says (Reese, Medscape Medical News, 11/15; Kane, Medscape Medical News, 11/15). 

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