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Survey: Flawed Health Care System Causes Doctors to "Bend" Ethical Norms to Best Serve Their Patients

San Diego—October 28, 2013

A survey among rheumatologists finds many face moral dilemmas when trying to do what’s best for their patients in the current health care environment. The study, titled “Bending’ Ethical Norms to Serve Patients’ Interests: Tensions in Medical Professionalism,” was presented at the American College of Rheumatology/ Association of Rheumatology Health Professionals Annual Meeting on October 28 in San Diego.

The complete study was published in the October issue of the journal Arthritis and Rheumatism.

Rheumatic diseases, such as rheumatoid arthritis and lupus, are a common cause of disability. Affecting all sectors of the population, they diminish quality of life and have a significant social impact. Despite the benefits of early treatment and effective therapies, access to rheumatologic services may be difficult, involving long wait times, even difficulties finding providers, according to C. Ronald MacKenzie, MD, a rheumatologist at Hospital for Special Surgery in New York City and lead author of the study.

“When people receive a diagnosis, the cost of effective treatment may render it unaffordable for many,” says Dr. MacKenzie, who is also chair of the American College of Rheumatology (ACR) Ethics and Conflicts of Interest Committee.  “While an optimal or fair system would mitigate these impediments to care, our survey of ACR members suggests that this is often not the case. In fact, physicians report they frequently find themselves in situations of ethical conflict in an effort to best serve their patients."

To conduct the survey, 14 closed-ended and two open-ended questions were sent electronically to 5,500 members of the American College of Rheumatology in the United States.

“We found that a pressing ethical issue for many rheumatologists is their perceived need to ‘bend’ ethical norms and compromise ethical principles in order to provide the care their patients need,’’ Dr. MacKenzie noted. In the survey, physicians reported ways in which they see themselves as ‘bending’ ethical standards and presented justifications for doing so. Examples included ‘embellishment’ of symptoms to help patients obtain prior authorization from insurance companies; stretching the truth to obtain needed drugs and testing for patients; and providing patients with certain diagnoses to obtain coverage for needed medications or physical therapy.

“The delivery of medical care takes place in a particular social context, and when this context includes conditions that are unfair, healthcare practitioners may be forced to struggle with ethical conflicts, making trade-offs that may go unrecognized or are not adequately discussed,”

Dr. MacKenzie said. “An awareness of this problem and its consequences is the first step in finding solutions to the challenges that physicians face.”

 

About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the ninth consecutive year) and No. 3 in rheumatology by U.S.News & World Report (2018-2019). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.

 

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