Family Medicine Grapples With Tough Choices Family Medicine Grapples With Tough Choices

More than half (58%) of family medicine physicians believe doctors who see patients should be required to be vaccinated against influenza, down from 68% in 2020.

That’s according Medscape’s 2022 “Tough Choices” survey about how they would respond to various ethically thorny challenges.

More than 4100 physicians from various specialties completed the semiannual survey, with 57% identifying as male and 40% as female. Approximately 540 identified themselves as family medicine specialists.

More than eight in 10 (81%) family medicine physicians say they have always reported suspected domestic abuse of a patient, while 15% have not always done so. The comparable percentages among physicians in the entire survey are 86% and 10%, respectively. Some observers, such as Thomas May, PhD, a bioethicist at Washington State University who discussed the survey results with Medscape Medical News, spoke up for required reporting laws regarding suspected abuse: “Required reporting is necessary and in the patient’s interests,” May said.

The plurality of respondents (41%) say physician-assisted dying is not appropriate for a patient in intractable pain. Three in 10 (29%) say the practice is permissible or that it depends on the circumstances (30%). While 10 states and the District of Columbia permit physician-assisted death in some cases, none allows it for intractable pain.

Most family medicine respondents (75%) say they would report a colleague for sexual harassment or bullying, with 19% saying it depends, and only 6% stating they would not report. “If we ignore bad behavior such as this by our colleagues, then we are hurting our profession,” one respondent said.

Far fewer family medicine physicians (53%) would report a doctor for making racist remarks than for sexual harassment or bullying. Three in 10 respondents (30%) say it depends, while 17% would not report such remarks.

Slightly fewer family medicine physicians support random drug tests of doctors (37%) than those who do not (40%), with the rest (22%) saying it depends.

“Doctors may feel like they’re being treated unprofessionally, like drug addicts, or question the accuracy of testing,” Arthur Caplan, PhD, a Medscape blogger and bioethicist at NYU Langone Medical Center, in New York City, told Medscape Medical News. But Caplan said random drug testing is justifiable nonetheless, citing “the moral right to protect patient safety and trying to drive down malpractice costs.”

Almost all family medicine physicians (80%) object to upcoding a patient’s medical condition in order to increase the patient’s odds of obtaining insurance coverage. Much smaller proportions say it depends (13%), or that upcoding is acceptable (7%).

Most family medicine physicians (69%) would not weed out a patient with multiple comorbid conditions using capitated plans. Almost one in five (19%), however, say it depends, and more than 10% (12%) would weed out patients in this way.

Half of family medicine physicians (50%) feel an ethical obligation to accept patients on Medicaid, despite red tape and low reimbursement rates. “All of us benefited in our education and residency from public funding. We owe those who cannot afford our care,” one respondent said.

Finally, a large majority of family medicine professionals (81%) believe it is important to publicly speak out against COVID-19 misinformation promulgated by public officials.

Marcus A. Banks, MA, is a journalist based in New York City who covers health news with a focus on new cancer research. His work appears in Medscape, Cancer Today, The Scientist, Gastroenterology & Endoscopy News, Slate, TCTMD, and Spectrum.

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