By Robert Lowes
WebMD Health News
Latest Prevention & Wellness News
Dec. 2, 2016 -- Seven percent of doctors 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 a new survey.
True, a clear majority of surveyed doctors -- 78% -- say it's never OK to cover up or avoid revealing such an error, according to the 2016 Ethics Report from Medscape, WebMD's sister site for health care professionals. However, the percentage who answered that way is down from 91% in 2014 and almost 95% in 2010.
The greater willingness of doctors 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 reduce malpractice suits. Some states have passed "disclose, apologize, and offer" laws to give health professionals a process for settling with injured patients.
Arthur Caplan, PhD, a bioethicist at NYU Langone Medical Center, says the increase in the percentage of doctors who'd hide a mistake with harmful consequences is "surprising and disturbing," especially when other sectors of the health care world are striving for greater transparency.
"This is a finding that makes me nervous," Kaplan says. "The shift is in the wrong direction."
Some doctors who answer "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 doctors to "disclose medical errors if they have occurred in the patient's care, in keeping with ethics guidance."
Changing views on placebos, patient relationships
Medscape's 2016 ethics survey uncovered other changes in professional attitudes.
Forty-five percent of doctors say they would prescribe a placebo for a patient who demanded it, almost double the percentage in the 2010 ethics survey. Many doctors 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 doctor to become romantically or sexually involved with a patient? Doctor scruples about this are softening. The percentage of doctors saying "no" to such relationships decreased from 83% in 2010 to 70% in 2016.
Only 2% of doctors say it's 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 doctor's practice. Yet another 7% say, "it depends."
The survey shows where doctors stand on a wide variety of ethical issues. For example:
- Seventy-eight percent say they would not withhold treatments or tests to avoid penalties for exceeding their organization's patient-care budget.
- Doctors are evenly split on whether they should undergo random drug and alcohol abuse testing -- 41% for, and 42% against.
- Twenty-five percent of doctors say they should not be required to get flu shots.
- Fifty-one percent say they would caution a patient against having a procedure performed by a colleague of questionable ability. Fifteen percent say no, and 34% say "it depends."
- Thirty-eight percent say they would drop a poorly paying insurer even at the cost of losing some longtime 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 say 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 7,500 doctors -- 63% of them female -- in more than 25 specialties. Roughly 1 in 4 is an internal medicine or family medicine practitioner. Thirty percent work in a hospital, while 40% work in an office setting as a soloist or a member of a group practice.
SOURCES: Medscape Ethics Report 2016 survey, Sept. 18-Oct. 19, 2016. American Medical Association Code of Medical Ethics. Arthur Caplan, PhD, bioethicist, New York University Langone Medical Center.
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