Wednesday, November 28, 2012

Differences in Ethics of UK vs. US Physicians

 A new report has come out from Medscape comparing marked ethical differences between United Kingdom physicians and US physicians.  The study surveyed over 25,000 US and UK  doctors on their beliefs about futile care, patient confidentiality, full disclosure to patients, and even informing patients about bad doctors.  It was surprising to me that doctors who are trained so similarly, have such divergent views when it comes to ethical issues.

On many of the questions the responses across the Atlantic were similar.  Only 10% (US) and 14% (UK) of physicians would hide information from a patient to bolster their spirit.  About a quarter of doctors on both continents might ration care to a younger, sicker patient rather than an older one.

An analysis of the findings points to differences in how doctors are paid as possibly driving the different values.  US doctors face more malpractice costs and face more litigation.  More US doctors work independently in a "fee for service" environment.  UK physicians are mainly funded by the country's socialized National Health Service (NHS) and decisions are less driven by financial concerns.

Here are the results of the survey:

Table. Differences in Attitudes Between US and UK Physicians, Medscape 2012 Ethics Report
Question US Physicians UK Physicians
Would you ever go against a family's wishes to end treatment and continue treating a patient whom you felt had a chance to recover? Yes: 23% Yes: 57%
Is it ever acceptable to perform "unnecessary" procedures due to malpractice concerns? Yes: 23% Yes: 9%
Is it right to provide intensive care to a newborn who either will die soon or survive with an objectively terrible quality of life? Yes: 34% Yes: 22%
Would you ever hide information from a patient about a terminal or pre-terminal diagnosis if you believed it would help bolster the patient's spirit? Yes: 10% Yes: 14%
Would you give life-sustaining therapy if you believed it to be futile? Yes: 35% Yes: 22%
Should physician-assisted suicides be allowed in some situations? Yes: 47% Yes: 37%
Would you inform a patient if he or she were scheduled to have a procedure done by a physician whose skill you knew to be substandard? Yes: 47% Yes: 32%
Is it acceptable to breach patient confidentiality if a patient's health status could harm others? Yes: 63% Yes: 74%
Would you ever decide to devote scarce or costly resources to a younger patient rather than to one who was older but not facing imminent death? Yes: 27% Yes: 24%

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