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, said in an interview. “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 IM and 38% in FM) 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 health care 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 versus being impaired at work or when on call,” one FM 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.