ACP Issues Revised Ethics Manual

The American College of Physicians this week issued a sixth edition of its ethics manual, the first rewrite since 2005.

The revised manual, published in ACP's flagship Annals of Internal Medicine, offers new guidance on longstanding issues such as end-of-life care, physician-industry relations, and ethics in medical research.

The manual also tackles emerging issues such as the role of social media and its impact on the physician-patient relationship, the growth and impact of the physician-employee model, treating celebrities in the age of Twitter, and physicians' dual role of serving patients' needs while also marshalling scarce or expensive healthcare resources.

"We're always facing challenging ethical issues," ACP President Virginia L. Hood, MBBS, told HealthLeaders Media.

"The common thread is to do what's in the best interests of the patient."
Hood, who also teaches at the University of Vermont College of Medicine in Burlington, says the growth of social media such as Twitter and Facebook has created potentially huge ethical sinkholes for physicians who don't use them correctly. 

"The boundaries may be blurred as physicians and patients interact more via social media, which is really the public domain," Hood says. "People use these in a private way and in a professional way, and it is important for physicians to recognize that and don't let the ease of using these social media create problems with the patient physician relationship or the profession itself. We have to make sure our professional demeanor is maintained whenever we are in the public eye."

Hood says the growth in the physician-employee model may resolve some ethical issues while raising new challenges.

"It goes both ways," she says. "As people are employed and paid in a lump sum for a job they do, it may take away some of the incentives that the current payment system has to encourage more procedures than maybe are necessary. All of the incentives in the system support volume rather than value. Having people employed may take away some of those incentives."

"On the other hand it brings up other issues, such as the institution making demands on how physicians treat patients or what tests or medications they are allowed to use, or pressures to get people out of the hospital sooner because it's better for the institution's bottom line," she says. "There are institutional pressures that can be pressed on employed physicians that we have to be concerned about. It is a growing trend and there might be more about that depending upon how healthcare is paid for."

As medical resources become more expensive or scarce, Hood says physicians may find themselves caught between the demands of patients and the greater society.

"The ethics of professionalism revolve around doing good, doing no harm, allowing patient autonomy and social justice—the equitable distribution of limited resources so everybody has the same chance to get what is needed," Hood says. "These are the principles one has to balance and the decision to do things that may cost more when you can do something that costs less just because a patient saw something on television. We are obligated as physicians not just to try to make the right decisions but to help patients make the right decisions."