September/October Ethics Reader Poll Results
Noam Stadlan, MD
Chair, NASS Committee on Ethics & Professionalism Department of Neurosurgery, North Shore Hospital Evanston, IL
Below are the results from the September/October Ethics poll.
Have you ever felt obligated to offer treatment (surgery, injection, or any other intervention) because conservative options were exhausted, even if the intervention was at best marginally indicated?
No
Yes - patients expect me to try something and not recommending something would be detrimental to my practice or my relationship with the patient
Yes - perhaps a psychological/placebo effect will occur and/or there is a non-zero chance of actual benefit
Yes - path of least resistance is easier than explaining the lack of options
Yes - productivity
Yes - other reason
Response from Dr. Stadlan
Physicians have an obligation to act in the best interests of their patients. Sometimes the best we can do is tell them that we can't do anything and/or provide reassurance that there isn’t anything significantly wrong or worrisome. I think it is important for us to be self-aware as to why we suggest treatments, especially when confronted with this situation.
While it can be reasonable to provide low-risk options knowing that part of the potential for improvement may come from a placebo effect, performing a procedure strictly for placebo effect without appropriate informed consent is problematic. Similarly, we need to be honest with ourselves as to whether our recommendations are for the patient’s benefit, or whether our own benefit — financial, psychic, or other — is playing a role. When in doubt, honesty with oneself and with the patients provides the best path forward.