By Debra Wood, RN, contributor Sep 25, 2018
In everyday practice, physicians face
numerous ethical questions, not just the weighty life-and-death ones. Less
dramatic questions pop up frequently—from taking gifts to sharing political
What’s the correct response according to the
code of medical ethics? Staff Care spoke to two experts who weigh in on some of
the most frequently asked ethical questions.
8 Common Ethical Questions for
physicians accept gifts from patients?
answer is a big “No,” said Celia B. Fisher, PhD, the Marie Ward Doty University
Chair in Ethics at Fordham University in Bronx, New York.“Gifts
from patients creates a blurring of lines between the physician's professional
role and a nonprofessional relationship with a patient,” Fisher said. “Reinforcing
a patient's perception of a personal relationship can impair the effectiveness
of the physician's recommendations for health compliance, and if the physician
feels an obligation to the patient based on a gift, can compromise the
people have suggested the value of the gift matters, and many institutions,
including Duke University Medical Center in Durham, North Carolina, limit the
value of the gifts that can be accepted or require they be shared with others
in the clinical area, such as food around holidays, said Philip M. Rosoff, MD,
MA, chair of the Duke University Hospital Ethics Committee.
“Anything more valuable is
felt to be such that it could cause the physician to treat the patient or her
family more deferentially or give preference to his care,” Rosoff explained.
2. Should doctors provide “VIP” care for
types of VIP care exist, such as a patient paying extra for special treatment,
perhaps a better room or food. Concierge medicine is another example of this.
The other type is when a patient is
treated differently because of who he or she is, say, a member of the board of
trustees of the institution or a major donor, Rosoff said. No matter what makes
them VIPs, physicians and advanced practitioners should not allow patients’ status
to cloud their professional judgment or behavior.
“Ironically, while those who are on the receiving end of VIP
may relish the prospect of being treated as ‘special’ – and it is reasonable to
assume that many ‘VIPs’ have this experience throughout their lives – data has
shown that VIP treatment is not so good and may be inferior to that given to
the less ‘privileged,’ especially at teaching hospitals,” Rosoff said.
doctors accept gifts from pharmaceutical company representatives?
Again for physician ethics, the answer is “No,”
“Taking gifts from pharma is a conflict of
interest that also compromises objectivity in terms of a potential perceived
obligation to prescribe a particular medication against data for other
medications and can also give the impression of a conflict of interest that can
compromise the patient's trust in the physician,” Fisher said.
gift-giver’s goal “is to influence the
prescribing and/or purchasing habits of the doctor,” Rosoff added. Academic
medical centers often institute bans on pharma or device reps.
“Even minor gifts bestow a sense of obligation on the
recipient, even if they may be unaware of it,” Rosoff said. “And, of course, as
we get to the bigger dollar items—like trips to sunny climates in the winter or
golfing jaunts or luxurious gourmet dinners with expensive wines—then the goal
of the companies is much more apparent.”
Should physicians “Google” their patients?
“Only if there is a concern regarding the
patient's safety or health that the physician believes may not be available
through health records or contact with patient,” Fisher said.
“There is also the problem of entering the
information gained from Google into the patient's health record, since there is
no guarantee that the information from Google is correct,” she continued. “Physicians
also need to be aware that based on HIPAA
patients have access to their health records and will appeal or question
information that is obtained from an unreliable source.”
Should doctors be friends with patients on social media?
“No, for the same reasons as not accepting
gifts,” Fisher said. “This creates a dual relationship blurring boundaries
between personal and professional roles, which can compromise physician
objectivity and patients’ trust in professionalism of recommendations.”
Patient Trust with Effective Doctor–Patient Communication
physicians report incompetence in a member of the healthcare team?
It depends, Fisher explained. For instance, if
the incompetence has not affected a patient and when informed about the need
for training, the other [person] takes appropriate steps to get the training
and refrains from treatment for which he or she is not trained, than a formal
report may not be necessary according to doctor ethics.
“If the team member is actively placing
patients in danger, it must be reported,” Fisher said. “The physician needs to
be knowledgeable about hospital procedures for reporting.”
doctors voice political opinions with patients?
Patients may bring up politics with
“The folk wisdom that one should not discuss politics or
religion at the dinner table also applies to discussing potentially ‘hot’
topics with patients,” Rosoff said. “Unless there is very good reason to
believe that the doctor’s political or religious views would have a positive
material impact on the care of a particular patient, there is no justification
to announcing that she is a Republican or supports such-and-such a candidate
for town council.”
Outside the clinical setting, Rosoff said it is OK for
physicians to voice political support.
physicians terminate non-adherent patients?
“If a patient is not complying with a medical
regimen and the physician has made all appropriate efforts to work with patient
to comply, then it is appropriate to let the patient know that further visits
are not likely to improve the patient's health,” Fisher said. “There is also a
potential problem in charging the insurance company for visits in which it is
assumed that treatment will not be effective.”
“However, a patient should not be left
without a provider, so the physician must provide the patient with a referral
to another provider who may be better suited to helping him or her adhere,”
The American Medical Association’s Code of
Medical Ethics includes information about these and other
doctor ethics challenges, including social media and political communications.
Top Ethical Challenges for Physicians
CHOOSE your best career option from hundreds
of locum tenens jobs
offered by Staff Care.
Contact a Recruiter Now