Endocrinologists Share Thoughts on Ethical Challenges End-shutdown

Endocrinologists share their views on a variety of ethical issues and sometimes heartbreaking decisions found in clinical practice in a new slideshow from Medscape titled, Right and wrong in medicine: Endocrinologists face tough decisions.

The report, part of a larger survey of 4,151 US doctors who completed an online survey between April and July 2022, details endocrinologists’ responses to questions covering some of the thorniest issues they face today. , ranging from patient privacy, sexual harassment concerns, appropriate social media participation, and physician-assisted dying.

In general, the endocrinologists’ responses mirrored those of the broader sample of US physicians, but not all.

When asked about physician-assisted dying, for example, only 41% of endocrinologists said they felt the practice, which is legal in 10 US states and the District of Columbia, should be allowed for terminally ill patients, compared to 52% of physicians overall.

About a third (31%) of the endocrinologists surveyed reported that “no,” the practice should not be legal, and 28% said “it depends.”

“The public and physicians feel more comfortable with [the idea of physician-assisted dying]University of Toronto clinical ethicist Eric Mathison, PhD, said in the report. “Physicians are seeing it in practice and listening to other physicians who are participating.”

On the topic of whether endocrinologists’ social media posts are unprofessional if the posts are unrelated to medical practice, 74% of respondents said “no,” and 13% said “yes” or “it depends.” “.

Corresponding responses from physicians were generally similar: 69% said “no,” 17% said “it depends,” and 14% said “yes.”

On the sensitive issue of whether it is acceptable to violate patient confidentiality when someone’s health could be threatened, 56% of endocrinologists answered “yes,” while 29% said “it depends” and 15% said “no.” .

“I teach that if you know someone is at direct risk of contracting a fatal disease, and you know who that person is, then you have a duty to warn,” said medical ethicist Arthur L. Caplan, PhD, a professor at the University of NY. of bioethics.

“The disease has to be serious to [breaching confidentiality] be morally defensible, and its disclosure has to be actionable,” he added.

The survey also inquired about various issues related to the behavior of physicians. On the question of whether endocrinologists should undergo random drug and alcohol testing, for example, only 39% of participants answered “yes,” 46% said “no,” and 16% answered “it depends.”

The topic can be uncomfortable for doctors. “Doctors may feel they are being treated unprofessionally, like drug addicts, or question the accuracy of the tests,” Caplan said. But he stressed the “moral fight to protect patient safety and try to reduce the costs of malpractice.”

And on the subject of whether a romantic relationship with a patient is appropriate, 67% of endocrinologists answered “no”; 22% answered “yes, after being no longer her patient for 6 months”, 9% answered “it depends” and only 1% said outright “yes”.

Commenting on this, Thomas May, PhD, a bioethicist at Washington State University, noted, “I’m not sure that 6 months after they stop being your patient is enough time. I think something like 2 years minimum. If you went to your oncologist and helped save your life, you can never be appropriate”.

And as to whether they would report a medical colleague for sexual harassment or bullying, 75% of endocrinologists said “yes,” 15% answered “it depends” and 10% said “no.”

When it came to reporting a medical colleague for making racist comments, 53% of endocrinologists said “yes,” versus 29% who said “it depends” and 18% who said “no.”

And as for speaking up when doctors spread dangerous misinformation, US Surgeon General Vivek Murthy, MD, in 2021 urged Americans to speak out against health misinformation during the COVID-19 pandemic. , and the vast majority of respondents agreed that endocrinologists should likewise speak out publicly against misinformation about COVID-19 from government or elected officials, with 76% answering “yes” to the suggestion; only 13% say “it depends” and 11% say “no”.

On the subject of the influence of the pharmaceutical industry, the survey asked if “[you could] accepting a meal or a concert from a pharmacist without influencing their prescribing habits,” to which 77% of endocrinologists responded “yes,” they could, with 12% responding “no” and 11%, ” depends”.

Caplan asks if some are fooling themselves. “Human beings feel indebted when they receive gifts,” he says in the report. “Doctors are no exception. If you get a meal or an invitation to speak for a small fee, you can still say ‘this is nothing to me,’ but it can result in subconscious favoritism.”

And in the ongoing debate about whether doctors are ethically required to accept some Medicaid patients, 46% of endocrinologists answered “yes,” while 35% answered “no” and 19% said “it depends.”

The proportion who agreed with the statement was somewhat lower than the 53% reported by doctors overall,” with 34% saying “no” and 12% saying “it depends.”

One respondent noted that “we all benefit from publicly funded education and residence. We owe it to those who cannot afford our care.”

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