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J Fam Pract. 1983 Aug;17(2):267-72.

Ethical decision making by family physicians.


One hundred thirty-one Illinois family physicians, 53 general practitioners, and 65 general internists responded to a survey on medical ethics. From these data emerged a profile of the family physicians and an identification of the ethical problems they encounter most frequently in their practice: (1) issues about contraception, (2) pain control, (3) telling the patient the truth, (4) sexual issues, (5) informed consent, (6) confidentiality, (7) controlling patients' behavior with medication, (8) sterilization, (9) professional etiquette, (10) patients' rights, and (11) peer review.


Illinois family physicians were surveyed to determine the ethical problems they encounter in practice. Family physicians were compared with 2 other primary care groups--general internists and the rapidly disappearing general practitioners. All 1851 physicians on the continuing education mailing list of Southern Illinois University School of Medicine were mailed a questionnaire that elicited anonymous responses. Responses were received from 669 physicians. Respondents selected for the present study were the 131 physicians who identified their specialty as family practice, 53 general practitioners, and 65 general internists. On the average, general practitioners in the study were older (58 years) than the family physicians (50 years) and the general internists (48 years). Proportionately more family physicians and general practitioners than internists were in solo practice, with more general internists in group practice. Family physicians were most likely and internists least likely to provide contraceptive aids to a teenage patient who requests them with or without parental permission. If a woman requested abortion, the behavior of each group of physicians did not vary substantially whatever the age or marital status of the patient. Family physicians and general practitioners were similar in that their most typical response was to refer the patient to a clinic for the abortion. A substantially larger number of internists than family or general practitioners would choose to refer the patient to a colleague. Family physicians reported confronting problems related to reproduction more often than either the general practitioners or the general internists. These problems include abortion, artificial insemination, birth defects, contraception, genetic counseling, sexual issues in general, and sterilization. Family physicians and internists did not differ markedly as to how they deal with informed consent and professional etiquette problems, but both reported encountering them with more frequency than general practitioners. All 3 groups of physicians encountered with equally high frequency problems relating to pain control, telling patients the truth, confidentiality, controlling patients' behavior with medication, and peer review. Family physicians and general internists identified patients' rights as an issue they need to consider very often in their practice.

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