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Views on Ethical Issues Shifting in Family, Internal Medicine

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Internal medicine physicians’ and family physicians’ attitudes have changed in recent years on several ethical issues, according to the Medscape Internal Medicine Ethics Report 2020 and the corresponding report for Family Medicine.

An example comes in an apparent loosening of attitudes about romantic/sexual relationships with former patients. Now, 31% of internists believe such a relationship is acceptable at least 6 months after the medical relationship has ended. That’s up from 22% in 2018. The number of family physicians this year who said 6 months later was acceptable also increased, but by a smaller margin — from 28% in 2018 to 33% in 2020.

“It’s acceptable as long as there is no undue influence,” David Fleming, MD, a member of the American Medical Association Council on Ethical and Judicial Affairs, told Medscape. “The important thing is that you don’t mix the two.”

Thoughts on Upcoding

Views on billing are also shifting. Ten years ago, 17% of physicians overall thought upcoding was acceptable when submitting claims or getting prior authorization. Today just 8% of physicians overall said it was, as did 8% of family medicine (FM) physicians, according to responses.

The number of internal medicine (IM) physicians clearly opposed to upcoding declined a bit from 79% in 2018 to 75% this year, while the number saying “it depends” increased from 11% to 15%.

Many responders in both specialties said they would upgrade a code in the interest of patient advocacy.

An internist put it this way: “If the system is set up so that the only thing that would work for the patient’s condition can be obtained by an upcode, then I would consider this.”

More Than a Third Say Random Drug Checks Needed

More than one third of physicians in both specialties (34% in internal medicine and 38% in family medicine) said physicians should be subjected to random alcohol and drug testing.

However, many say testing should only happen if abuse is suspected.

Some said specialty matters when it comes to random checks. An internist responded, “I think this is more important for procedure-based physicians.”

Some family physicians said that if other healthcare workers were subjected to the same checks in the same circumstances they would not object, but said doctors shouldn’t be singled out.

Vast Majority Would Report an Impaired Peer

Nine out of 10 internists and family physicians say they would report a physician who occasionally seemed impaired but most (60% of IM respondents and 62% of FM respondents) said they would do so only after talking with the physician first.

Some noted their decision would depend on the setting.

“Big difference if they are on vacation and drink too much so they need a ride home, vs being impaired at work or when on call,” one family medicine physician said.

About one third of family physicians (34%) and internists (33%) now favor physician-assisted dying/suicide for incurable suffering. A substantial number (26%-28%) hesitated to make a clear decision in both specialties, responding  “it depends.”

“Patient control over quality of life can be even more important than control over its quantity/duration,” one internist wrote.

The proportion of physicians who agreed physician-assisted dying/suicide should be legalized for the terminally ill was much larger, with 49% of family physicians and 52% of IM physicians saying it should.

Talking Politics

Data in this survey were collected in summer months of 2020, before the US presidential election, in a highly polarized climate. Some numbers reflect increasing distaste for such conversations with patients.

For example, the number of family physicians who said talking about politics with patients was ethical dropped from 31% in 2018 to 23% in the latest survey. The numbers remained nearly flat among IM physicians in the past two years — at 21% in 2018 and 23% this year.

Should a Flu Shot Be Mandatory?

Almost three fourths of physicians overall — and 76% of IM physicians — say annual flu shots should be required for physicians who have patient contact. Agreement was somewhat lower among family physicians at 68%.

Some family physicians cited “freedom of choice” and that they would want to see a higher effectiveness rate before they were mandatory.

Data for this survey, with 5130 respondents, were collected before COVID-19 vaccines became available.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News and Nurse.com and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.

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