Doctors’ personal beliefs can hinder care
SuzannePjam
Posts: 411
I know this forum has posted thoughts on pharmacists not filling perscriptions based on their moral beliefs, but for doctors not to give patients their options because they don't believe in them morally is unconscionable. It is a doctors duty to give all legal options available to their patients for whatever ails them, or to at the very least refer them to another doctor who would be willing to do so if they won't.
Doctors’ personal beliefs can hinder care
Survey: Many religious physicians stay mum on controversial treatments
A disturbing number of doctors do not feel obligated to tell patients about medical options they oppose morally, such as abortion and teen birth control, and believe they have no duty to refer people elsewhere for such treatments, researchers say.
The survey of 1,144 doctors around the country is the first major look at how physicians' religious or moral beliefs might affect patients' care.
The study, conducted by University of Chicago researchers, found 86 percent of those responding believe doctors are obligated to present all treatment options, and 71 percent believe they must refer patients to another doctor for treatments they oppose. Slightly more than half the rest said they had no such obligation; the others were undecided.
"That means that there are a lot of physicians out there who are not, in fact, doing the right thing," said David Magnus, director of Stanford University's Center for Biomedical Ethics.
According to an American Medical Association policy statement, doctors can decline to give a treatment sought by an individual that is "incompatible with the physician's personal, religious or moral beliefs." But the physician should try to ensure the patient has "access to adequate health care."
Tens of millions perhaps affected
The survey did not examine whether these doctors act on their beliefs — that is, whether they actually withhold information or refuse to refer patients. But the researchers calculated that tens of millions of Americans might be going to such doctors.
"Conscientious objection is fine ... as long as it doesn't conflict with the rights of the patient," Magnus said. "You can't abandon the patient or essentially coerce the patient by saying you won't do the procedure or refer them to someone else."
The study was published in Thursday's New England Journal of Medicine and led by Dr. Farr Curlin, a University of Chicago ethicist and internist. The findings were based on a survey mailed to 1,820 practicing U.S. family doctors and specialists, chosen randomly from a national database; 63 percent responded.
Doctors describing themselves as very religious, particularly Protestants and Catholics, were much less likely than others to feel obligated to tell patients about controversial treatments or refer them to other doctors, and were far more likely to tell patients if they had moral objections.
Overall, 52 percent said they oppose abortion, 42 percent opposed prescribing birth control to 14- to 16-year-olds without parental approval, and 17 percent objected to sedating patients near death.
Differences between female, male doctors
Female doctors were much more likely than male ones to feel obligated to refer patients for treatments they personally oppose, far less likely to present their own objections to a patient and slightly more likely to disclose all treatment options.
Dr. Jeffrey Ecker, chairman of the committee on ethics at the American College of Obstetricians and Gynecologists, said he was encouraged that most doctors agreed patients deserve to be told about all appropriate medical options and referred to other doctors when needed.
"There is reason to be concerned about those that don't do it," Ecker said. He added that it is possible many doctors in the survey who opposed such disclosures and referrals may be practicing in specialties where they don't face those issues.
He said doctors must let patients explicitly know if they are opposed to particular services.
Problem area: Care for rape victims
One big problem area, Magnus said, involves emergency room doctors and emergency contraception for rape victims. He said it is considered standard care to offer the morning-after pill, but that is not done in some Catholic hospitals, according to one small study. Ecker said doctors opposed to emergency contraception should avoid working in an ER for that reason.
Curlin noted prior research by his team found doctors may be a bit more religious than others — 46 percent of doctors said they attend religious services at least twice a month, compared with 40 percent of the general public. But he found doctors are less likely to carry their religious beliefs into their daily work, with 58 percent saying they do so, versus 73 percent of the general public.
Curlin said that in light of the new survey findings, if a patient "anticipates wanting a controversial treatment and they don't know already if their physician opposes it, then they should ask."
"I hope it leads to more substantive conversations between doctors and their patients," he said.
Doctors’ personal beliefs can hinder care
Survey: Many religious physicians stay mum on controversial treatments
A disturbing number of doctors do not feel obligated to tell patients about medical options they oppose morally, such as abortion and teen birth control, and believe they have no duty to refer people elsewhere for such treatments, researchers say.
The survey of 1,144 doctors around the country is the first major look at how physicians' religious or moral beliefs might affect patients' care.
The study, conducted by University of Chicago researchers, found 86 percent of those responding believe doctors are obligated to present all treatment options, and 71 percent believe they must refer patients to another doctor for treatments they oppose. Slightly more than half the rest said they had no such obligation; the others were undecided.
"That means that there are a lot of physicians out there who are not, in fact, doing the right thing," said David Magnus, director of Stanford University's Center for Biomedical Ethics.
According to an American Medical Association policy statement, doctors can decline to give a treatment sought by an individual that is "incompatible with the physician's personal, religious or moral beliefs." But the physician should try to ensure the patient has "access to adequate health care."
Tens of millions perhaps affected
The survey did not examine whether these doctors act on their beliefs — that is, whether they actually withhold information or refuse to refer patients. But the researchers calculated that tens of millions of Americans might be going to such doctors.
"Conscientious objection is fine ... as long as it doesn't conflict with the rights of the patient," Magnus said. "You can't abandon the patient or essentially coerce the patient by saying you won't do the procedure or refer them to someone else."
The study was published in Thursday's New England Journal of Medicine and led by Dr. Farr Curlin, a University of Chicago ethicist and internist. The findings were based on a survey mailed to 1,820 practicing U.S. family doctors and specialists, chosen randomly from a national database; 63 percent responded.
Doctors describing themselves as very religious, particularly Protestants and Catholics, were much less likely than others to feel obligated to tell patients about controversial treatments or refer them to other doctors, and were far more likely to tell patients if they had moral objections.
Overall, 52 percent said they oppose abortion, 42 percent opposed prescribing birth control to 14- to 16-year-olds without parental approval, and 17 percent objected to sedating patients near death.
Differences between female, male doctors
Female doctors were much more likely than male ones to feel obligated to refer patients for treatments they personally oppose, far less likely to present their own objections to a patient and slightly more likely to disclose all treatment options.
Dr. Jeffrey Ecker, chairman of the committee on ethics at the American College of Obstetricians and Gynecologists, said he was encouraged that most doctors agreed patients deserve to be told about all appropriate medical options and referred to other doctors when needed.
"There is reason to be concerned about those that don't do it," Ecker said. He added that it is possible many doctors in the survey who opposed such disclosures and referrals may be practicing in specialties where they don't face those issues.
He said doctors must let patients explicitly know if they are opposed to particular services.
Problem area: Care for rape victims
One big problem area, Magnus said, involves emergency room doctors and emergency contraception for rape victims. He said it is considered standard care to offer the morning-after pill, but that is not done in some Catholic hospitals, according to one small study. Ecker said doctors opposed to emergency contraception should avoid working in an ER for that reason.
Curlin noted prior research by his team found doctors may be a bit more religious than others — 46 percent of doctors said they attend religious services at least twice a month, compared with 40 percent of the general public. But he found doctors are less likely to carry their religious beliefs into their daily work, with 58 percent saying they do so, versus 73 percent of the general public.
Curlin said that in light of the new survey findings, if a patient "anticipates wanting a controversial treatment and they don't know already if their physician opposes it, then they should ask."
"I hope it leads to more substantive conversations between doctors and their patients," he said.
"Where there is sacrifice there is someone collecting the sacrificial offerings."-- Ayn Rand
"Some of my friends sit around every evening and they worry about the times ahead,
But everybody else is overwhelmed by indifference and the promise of an early bed..."-- Elvis Costello
"Some of my friends sit around every evening and they worry about the times ahead,
But everybody else is overwhelmed by indifference and the promise of an early bed..."-- Elvis Costello
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I've encountered this first-hand, when I was working at the rape crisis center, and I don't think I've ever been more furious. There's nothing quite like driving around at 3 a.m. with a traumatized woman who just wants to go home, trying to find someone who will give her perfectly legal, effective and necessary medication. Also nothing quite like realizing that she wouldn't have even known she had the option if I hadn't been there! :mad:
I now I just got back from a couple day wildlife adventure tour and I specifically asked for for the most reckless guide they had. Knowing that within the realms of their responsibility some will embrace more risk and others less. I wanted the more risk guide.
when it hits you, you feel to pain.
So brutalize me with music.”
~ Bob Marley
UNREAL!!!
www.myspace.com/jensvad
exactly. Doctors shouldn't be forced to perform a procudure they dont agree with; however, they should be required to refer a patient to a different physician.
yes, but the final choice is up to the patient, so a doctor is obligated to inform the patient of their options. if they do not want to perform certain procedures, no problem. but they cannot hide valid options from patients.
you're talking about scheduling in advance a recreational outing at your leisure. we're talking about situations like hippiemom described where there is an emergency and time is of the essence. they don't necessarily have time to ask around and evaluate all ther options. they count on the doctor providing them with a full and accurate account of their options of treatment.
...are those who've helped us.
Right 'round the corner could be bigger than ourselves.
I agree in principle, but there's a wide range of knowledge among doctors. Your general physician might not even KNOW all of the legal and scientifically sound options...especially if it is emerging therapies.
And how many times have you gone in with the flu, and the doctor ran through the entire litany of ways you could be treated and let you choose? They usually just pick one, no?
...are those who've helped us.
Right 'round the corner could be bigger than ourselves.
We're not talking about treatments for obscure diseases that were approved last week, and perhaps not every doctor is aware of them yet. All gynocologists, all primary and emergency care physicians, are well aware of abortion and the various methods of birth control. All doctors are aware that there are differing philosophies on how to treat terminal patients at the end of life. And all doctors should be capable of accepting that these decisions are not theirs to make. They have an obligation to pass their knowledge along to their patients, to make them aware of their full range of options, and to refer them to someone who will abide by their wishes. Anything less is negligent care.
this makes me want to cry, becos it's so simple and common-sense... yet it is so hopelessly and depressingly wasted on mindless religious devotees like him.
A doctor is no different from a cop or anyone else. His own personal beliefs can and will sway his behaviour. If you want a doctor that leaves all of his own thoughts and beliefs and interpretation of his knowledge out of the equation, hire a computer to be your doctor.
www.myspace.com/jensvad
bullshit. a lot of cops think the war on drugs is a a failure and it's stupid to lock up people for smoking pot. but they still arrest people for it. certain civic duties demand that you put your clients' needs above your own personal views. lawyers, police, judges, doctors, etc all fall under this category.
of the doctors i have now, my oncologist is mid 60s male. we don't get along because i questioned and refused the treatment he prescribed....i went with less harsh chemo and quality of life rather than strong chemo and quantity. my surgeon is a late 40s female....my gyno is a male in his mid 30s. those 2 LISTEN to me...work with me....and work together as a team to make my life easier.
over the years, i've seen this time and time again. so i'd lay odds that most of the doctors who practice according to their beliefs/won't refer are older.
And alot of cops let the potsmokers go with a warning. And alot of ad's choose to not press charges. And alot of judges give probation rather than maximum penalties. Your comparision is a lousy one. THOSE people are using THEIR beliefs as much as any doctor out there, in determining what they feel is appropriate. Thanks.
www.myspace.com/jensvad
There are a lot of variables that go into a decision whether or not to prosecute any given case, but if a DA makes that decision based on his own personal feelings about the law, then he too is oversteppting his bounds and not doing his job.
It's a perfectly valid comparison. There are cops, lawyers and doctors who act outside the scope of their jobs. All three are wrong.
No, all three are human. If you want action without emotion or personal beliefs coming into play, hire a fucking robot.
www.myspace.com/jensvad
from my window to yours
i think you're wrong on all 3 of these counts. a cop might opt for a warning, but he still lets the offender know he was in violation of the law. he doesn't just say "oh, just wanted to say hi... no no, no problem with smoking pot here." he gives the offender full information but refuses to act in opposition to his conscience to a small extent. i disagree with that, if pot is illegal cops should be enforcing it and your violation of the law shouldn't depend on how sympathetic the arresting officer is. regardless, as i said, they still know where they stand with the law. if a doctor feels he cannot in good conscience prescribe x medicine or perform an abortion, that is one thing (akin to not arresting a pot smoker)... but he is still professional obligated to inform the patient of their options to pursue other treatments elsewhere (akin to giving a warning instead of arrest).
however, if you don't like that... what about teachers and professors? i know you neocons love to bitch about liberal professors spouting off their ideology to a captive student audience. should a teacher be using their position as a pulpit to select what parts of the curriculum are communicated to students? if a teacher is, say, a holocaust denier, should they be allowed to ignore large chunks of history about ww2 just becos of their personal beliefs? should a staunch atheist use his biology or physics class to talk about the evils of religion instead of science?
Are doctors ethically and/or professionally bound to tell a patient of all possible courses of treatment?
If not, should they be professionally and/or ethically bound?
when it hits you, you feel to pain.
So brutalize me with music.”
~ Bob Marley
exactly.
i don't think anyone is expecting or asking a doctor to go against his/.her personally held beliefs. sharing ALL available information and courses of treatment is part of their job description. actually administering such does not have to be. a doctor can, and should, be expected to offer the information and beyond that....suggest seeing another physician for said treatment if the patient wants it but the doctor does not want to provide such service. anything else to me is negligence on the part of the doctor.
Let's just breathe...
I am myself like you somehow
I personally believe it's unethical, but don't know what the law is on that. I think if a doctor knowingly withholds treatment options from the patient because they don't agree with the treatment, in areas other than reproduction, everyone would agree that it's wrong. For example, if a woman has breast cancer, just because a certain doctor doesn't necessarily agree with chemotherapy doesn't mean he shouldn't give her the option of it. The same should apply to birth control and the morning after pill and abortions.
"Some of my friends sit around every evening and they worry about the times ahead,
But everybody else is overwhelmed by indifference and the promise of an early bed..."-- Elvis Costello
Doctors should make patients aware of different treatments for certain diseases. But doctors are also reading and finding out new information all the time and what may work for some people doesn't nec work for everyone. Sometimes a doctor doesn't mention a treatment b/c he's fairly sure that the said treatment isn't what the patient needs...not every clinical picture is the same. There are also doctors who won't offer options based on values.
The hard part about the second question is teh professional leway and professional judgement that comes into play with each patient and with each treatment. Should I voluntarily tell a patient every option available and then place the onus on the patient to make the decision? I think that depending on the case you should provide a couple of reasonable options that the physician is 1. comfortable with and 2. confident with for treatment...if the patient asks about new or controversial treatment the doctor is at least obligated to address it then and refer if the patient wants to explore that avenenue.
End of life issues are another area. Some doctors will agressively manage pain even if it might hasten death, others will not. Doctors need to be very upfront with their patients about which type of doctor they are. This is a very serious and very final decision that only the patient (or her designated agent) should be making.
I agree that the physicians should be up front with the patients re: their stance on those issues, no doubt. I think communication is something that is lacking on the doctors parts a lot of the time, b/c of the vast amount of people they see in a given day. That's a poor reason, but that's the reality right now. I also think ( and know from conversations) that docs are frustrated with the amount of information and disinformation out there (internet / ads etc..) people spend 5 minutes online and come in and "know" the best treatment already...but that's a different topic.