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Monday, February 12, 2007

I should have blogged on this NEJM article last week when the WaPo and several other newspapers picked it up. It's a study of the ethical behavior of doctors with regards to referrals, and whether or not they'll allow their personal morality to interfere with their job.

I'll admit I'm disappointed by the results.

A total of 1144 of 1820 physicians (63%) responded to our survey. On the basis of our results, we estimate that most physicians believe that it is ethically permissible for doctors to explain their moral objections to patients (63%). Most also believe that physicians are obligated to present all options (86%) and to refer the patient to another clinician who does not object to the requested procedure (71%). Physicians who were male, those who were religious, and those who had personal objections to morally controversial clinical practices were less likely to report that doctors must disclose information about or refer patients for medical procedures to which the physician objected on moral grounds (multivariate odds ratios, 0.3 to 0.5).

I think the moral of the story is that you should avoid male and religious doctors. They will make paternalistic decisions that are not in your best interests about your medical care, and they really should just eat shit and die for being so morally sanctimonious. I mean really, you're a professional! Do your job! Since when did it become ok to get a career when you know doing your job correctly will interfere with your moral code? And it's not like you couldn't still be a doctor. Just go into psych, or pathology, or derm, or orthopedics, there are dozens of specialties that would avoid such "moral" conflicts. While the survey was a cross-section across specialties the authors unfortunately did not provide information that would suggest that the doctors who responded incorrectly had decided on specialties that would remove such conflicts from their daily practice. It's hard to tell if this is a real problem if the majority of the docs who said they would withhold information and referrals were those involved in primary care or specialties like OB/Gyn. Either way, it's a sad sign, and taken on its own suggests that you should ask your doctor questions about their moral codes before allowing them to treat you. It's a sad day for medicine as a profession when 14% of doctors feel like they can impose their morality on patients, and a full 29% won't give referrals for things they personally object to.

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