Background/Purpose: The rheumatic diseases are a common cause of short and long-term disability. Affecting all sectors of the population, they diminish wellbeing, affect quality of life, and have a significant social impact. In spite of the benefits of early treatment and ever more effective therapies, access to rheumatologic services is often inadequate, involving long wait times, and difficulties finding providers; moreover the cost of effective therapy renders treatment unaffordable for many. A just system would mitigate these impediments to care, but in unjust context physicians might find themselves in situations of ethical conflict. We herein focus on the effects that the current practice context has on how rheumatologists’ view their ethical responsibilities.

Methods: A survey consisting of 14 closed-ended and 2 open-ended questions, was developed, pilot tested, and sent electronically to 5,500 members of the ACR in the United States. A second email requesting participation was sent to increase the response rate. Reported herein are the results of the open-ended component.

Results:  A pressing ethical issue for many rheumatologists is their perceived need to ‘bend’ ethical norms and compromise ethical principles in order to serve their patients’ interests. In the survey physicians report ways in which they see themselves as ‘bending’ ethical standards and presented justifications as to why they do so. Examples include, ‘embellishment’ of symptoms to help patients obtain prior authorization; downcoding to help the less fortunate; stretching the truth to obtain drugs and testing; and label patients with certain diagnosis that they do not have so as to obtain coverage for medications or physical therapy. The ethical implications of these challenges for the physicians’ sense of integrity, their responsibilities towards their patients, and the impact on justice in the health care system are considered.

Conclusion:  The results of our questionnaire indicate that, in the context of inadequate access to care, rheumatologists wrestle with ethical dilemmas concerning how to fulfill their responsibilities to their patients. As the delivery of medical care takes places in a particular social context, the extent to which the context involves unjust conditions forces healthcare practitioners to struggle with ethical conflicts, making trade-offs that are often not sufficiently recognized. In order to provide solutions to the resultant ethical and professional challenges faced daily by physicians, an awareness of this problem and its consequences is necessary.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/bending-ethical-norms-to-serve-patients-interests-tensions-in-medical-professionalism/