Medical ethicist Art Caplan was back on Boston Public Radio for his weekly "Ask the Ethicist" segment with Jim Braude and Margery Eagan. Caplan talked about doctors who work sick even though they shouldn't; the relative ineffectiveness of online symptom-checking services; and how an NFL star's medical records were tweeted out by a journalist.
Art Caplan is head of the division of medical ethics at NYU's Langone Medical Center, and host of the Everyday Ethics podcast. Questions below have been paraphrased, and Caplan's answers are edited where noted [...].
A new study found 95 percent of doctors knew it was wrong to work while sick — and 83 percent of them did it anyway. How is that possible?
Bad, bad bad. [...] You don't want to be there when you're sick. That said, the institutions, or hospitals, clinics, workplaces do not support them staying home. I mean, if you ask [doctors] how many sick days do you get, [...] they say, 'Boy, I'm expected to work if I can crawl into this place.'
Are they under too much pressure to come in?
There's too many people going in sick. It's not what healthcare wants to stand for, it's not the way to put your patients first. I mean, that's what we've got to do. [...] It's not like there's a surplus of health care workers. If somebody's out, they're scrambling. [...] It shouldn't be that way, it's wrong, but it's been that way for a long time.
A Harvard Medical School study found that online 'symptom checkers' — the WebMDs of the world — only offered a correct diagnosis in 34 percent of cases. These will get better, right?
Yeah, it's got to get better. [...] It's in its infancy. We don't know how to handle diagnostics [...] very well online. [...] It's gotta be in our future because as we've said on this program two billion times, there aren't enough primary care doctors. [You've got] rural folks, people who need healthcare in the middle of the night when the healthcare system is just down in some places.
As online health diagnostics get better they could substantially help with those cases, right? We could add things like minute clinics and other measures designed to quickly diagnose and treat without an official doctor visit.
I still would head off to the doctor or the emergency room. [...] Can you commit malpractice in a 'minute clinic?' I know they get you to try to sign waivers. [...] It isn't clear how errors get handled, or how malpractice gets handled.
How do we make these things better?
The companies that are involved with it are just startups. [...] It's just because it's new, so they're not sure. Well, what are the qualifications of the doctor to do this kind of work? [...] If you're batting .300 — pretty good to get into the All-Star Game — not good [enough] for dealing with patients.
Members of the House of Representatives just passed a bipartisan measure called the 21st Century Cures Act. It could speed up the FDA's drug approval process, make medical research easier, and would empower the FDA and National Institutes of Health with money to make these things happen. What do you make of this?
It's a complicated thing. The drug approval process I think works pretty well. We want things to move fast, and [...] then somebody dies in a research study, and 'What the heck is going on? Slow it down!'
So we want quick drug approval until something bad happens.
It's what I call the ongoing pendulum of American attitudes on research. [...] We're kind o f schizophrenic. What we dream of is risk-free, fast research. [What we have ] is risky research. [If] you're going to have to take more risk at the front end, we're going to see more bad outcomes.
Where does the US stand in the world in terms of medical innovations? How do other nations regard our approval process for drugs and treatments, for example?
The rest of the world looks to us. Even though there are regulators everywhere else, the FDA is the gold standard, so we tend to set the pattern. The US is a major market.
In spite of that, the FDA gets bad press.
I think the FDA has been getting better. They recently streamlined their processes for [online applications for drugs]. They focus on the bureaucracy.
New York Giants defensive end Jason Pierre-Paul injured his hand in a fireworks accident around Independence Day. The injury required hospitalization, and the amputation of one of his fingers. An NFL reporter tweeted out medical documents related to his hospitalization. Was it unethical for him to do so?
We know he lost a finger and has severe burns. [HIPPA] is supposed to give us all privacy of our medical records, although that only applies to doctors and nurses. [It's wrong] to post records up there, it just shouldn't be done. I don't think reporters should be doing that. [...] You look at celebrities and their medical privacy, it's somewhere between nothing and no-how. [Media are] bribing nurses, they're paying off medical students. [...] I like privacy, I believe privacy is important. I wonder if privacy isn't going the way of the horse and buggy.
A report on the American Psychological Association found that the APA colluded with the CIA to aid in that organization's interrogation techniques after September 11th. This is unethical, right?
People were definitely testing things like water-boarding, definitely testing things like sensory deprivation. [...] There were many, many forms of stressing the body that were tested. [...] When the military and patriotism mix, year after year medicine throws its ethics away — so does psychology — and gets on board. And it's a problem. You want medicine and psychology to protect the health of people, not to torture people.
The justification was that the country was threatened by outside actors, and that everybody was now on the same team, protecting the US.
They had to know better. [...] Whenever people say 'we're at war, we're at total war, the security of the state is threatened by terrorists,' [...] people invoke national security and they invoke homeland security, and it's really tricky. It's not that I don't understand that. I understand people trying to fight.
