Docs Tongue-Tied on Treatment

Medical Doctors Withhold Information on Treatment Options

GENE EMERY / Daily Telegraph (Australia) 9feb2007

Do not always expect straight talk from your doctor about treatments they disapprove of — 14 per cent of physicians believe it's acceptable to withhold information about topics such as birth control, abortion and sedating dying patients, according to a study.

In addition, 29 percent feel no obligation to tell patients where they can go to get that care.

Most of the 1,144 American doctors who responded to the poll, accord to a report in the New England Journal of Medicine, [Religion, Conscience, and Controversial Clinical Practices - New England Journal of Medicine 8feb2007] supported full disclosure and referral to another health care provider if they had moral objections to a treatment or procedure.

"If physicians' ideas translate into their practices, then 14 per cent of patients — more than 40 million Americans — may be cared for by physicians who do not believe they are obligated to disclose information about medically available treatments they consider objectionable," Dr. Farr Curlin of the University of Chicago and colleagues wrote.

"In addition, 29 percent of patients — or nearly 100 million Americans — may be cared for by physicians who do not believe they have an obligation to refer the patient to another provider for such treatments."

Men, Christian doctors and physicians with the strongest religious beliefs were most likely to say it is permissible to withhold information and not help a patient find another source of controversial care.

The findings mean that "if you anticipate wanting access to an area of medical treatment that may be controversial, you might want to have a frank conversation with your physician up front," Curlin said in a telephone interview.

Dr. John Lantos, also of the University of Chicago, called that the "let the buyer beware" approach. "If they don't like the answer, they should find a different doctor."

Plenty of doctors object to something, the survey found.

"For example, 52 percent of the physicians in this study reported objections to abortion for failed contraception, and 42 per cent reported objections to contraception for adolescents without parental consent," Curlin's team wrote.

They found that 86 per cent of the doctors believed in presenting all options and 71 percent would refer patients to another doctor who does not object to the requested procedure.

The study concluded that patients should ask their doctors outright about various options.

The survey showed that many doctors accommodate patients even when they have moral objections to certain situations.

For example, 42 per cent said they do not approve of providing contraception to teenagers unless a parent agrees.

Yet among the doctors who object, only 22 per cent said physicians are not obligated to disclose all possible options to the teen.

And when it came to giving patients information about terminal sedation, a practice that only 17 per cent of the doctors found objectionable, only 11 per cent of the doctors with moral reservations said doctors can withhold information.

"When we train doctors we encourage them to try to be ethical, and to practice ethically they must first make judgments in any situation about what is good," Curlin said.

"They also have to have the will to do what they judge to be good. And in our culture, where there are so many possible uses of medical technology, people will disagree at times on what is permissible."

source: 13feb2007