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New Ethics Survey Includes Mask Wearing, Upcoding Conditions

Despite being deep into a pandemic this year, tension about wearing a mask continues, and physicians and other clinicians have been called out recently either for preaching about masks’ effectiveness and then going maskless in their off time or for bragging that they aren’t wearing masks at all.

In a new Medscape survey that presented ethical scenarios, physicians were asked, “Is it ethical to refuse to wear a mask in public areas when others are around?”

Thirteen percent answered yes; 14% said, “No, because it infringes on personal freedom”; 60% answered, “No, for other reasons”; and 13% said, “It depends.”

A pediatrician in the survey commented, “Wearing a mask primarily protects others. Not wearing a mask is selfish and inexcusable.”

Would You See a Patient Who Won’t Wear a Mask?

Most physicians (68%) would refuse to see a patient who won’t wear a mask or keep social distance in their office, but 18% said they would not refuse to see them, and 14% said, “It depends.”

Office-based physicians were more likely than hospital-based physicians to refuse to see those patients (71% vs 60%).

Doctors were also asked whether it is ethical for physicians to discuss their political beliefs with patients.

Almost half (45%) said no, but 19% said doing so was ethical, and 36% answered, “It depends.”

A general surgeon wrote, “Cripes, it’s bad enough as it is with your uncle at a Sunday dinner.”

A urologist said, “Yes, I’m a human being and entitled to my opinions.”

Would You Limit Medicaid Patients?

The pandemic has resulted in job loss and subsequent loss of employer insurance. It has been estimated that the number of uninsured persons has increased by 3 million to 8 million, the survey authors write.

Physicians were asked whether they would limit the number of Medicaid patients in their practice, given that many of their patients might have to switch to Medicaid this year; 63% said they would not; 10% said they would; 12% said they already do; and 15% said, “It depends.”

The numbers were different between employed and office-based physicians. Although three quarters of employed physicians said they would not limit Medicaid patients should the numbers go up, only half of office-based physicians said so.

An ophthalmologist explained, “I have high overhead. I cannot survive on low payers.”

A psychiatrist said, “I will continue to see my past patients regardless of their insurance or ability to pay, but I would not take any new patients on Medicaid.”

Is It Morally OK to Upcode a Patient’s Condition for a Prior Authorization?

Fewer physicians this year said it was morally acceptable to overstate or upcode a patient’s condition when submitting claims or seeking prior authorization.

This year, 8% said yes; 78% said no; and 14% checked, “Rather not answer.”

A decade ago, the authors note, 17% said yes; 73% said no; and 9% said, “It depends.”

That may be attributable to stricter penalties against the practice, the authors write. In 2019, the US Department of Justice received $2.6 billion in settlements and judgments from civil cases involving fraud and false claims in the healthcare industry.

Would You Prescribe a Placebo-Type Treatment?

Another survey question asked whether physicians would ever prescribe a placebo-type treatment (unlikely to help but less likely to harm) to a patient who doesn’t need treatment but is adamant about receiving something.

A little more than a third (34%) answered yes; 47% answered no; and 19% said, “It depends.”

The percentage of respondents who answered yes was higher than a decade ago when the question was asked, the survey authors report, likely because of the rise in emphasis on patient satisfaction scores and concern about online ratings.

Another question asked about “weeding out” patients.

Younger physicians were more likely than older physicians to say they would exclude patients with many comorbid conditions if their practice had a capitated plan or profit sharing/shared savings plan.

For doctors younger than 45, 18% answered yes; 61%, no; and 21% answered, “It depends.” Among doctors at least 45 years old, 10% said yes; 73% said no, and 16% said, “It depends.”

Romantic Boundaries With Patients

Questions of romantic relationship boundaries draw varied answers in surveys, and this year was no exception.

Overall, romances with patients are still considered taboo, the survey authors note, but over the past decade, such relationships appear to have become slightly more acceptable.

The reason may be that patients are able to view personal information and read social media posts about their physicians online. Another possible factor is that some patients now text their physicians or call them by their first name.

As to whether it is ever acceptable to become romantically or sexually involved with a patient, 2% said yes; 26% said, “Yes, after they’ve stopped being your patient for six months”; 62% said no; and 10% said, “It depends.”

Female physicians were less accepting of such romantic relationships than were men. Among female physicians, 69% said no, and 8% said, “It depends”; 58% of their male counterparts said no, and 10% said, “It depends.”

Comments on the survey reflect sharp division on the issue.

A gastroenterologist commented, “There are some instances where such relationships can be healthy and beneficial for both parties. If a physician treats a patient for a cold at an urgent care center and then runs into them in a grocery store and discovers compatibility, is that a problem?”

A cardiologist answered the question more pointedly with, “Hell, no! That is inappropriate, illegal, and disgusting.”


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