Friday, April 23, 2010

Doctors' Dilemma: Denominational Hospitals.

Tom Rees writes at Epiphenom about the challenge faced by doctors who work at denominational hospitals -- about 1 in every 8 -- in the U.S. Rees highlights a recent study that polled doctors on how they handled religious restrictions to medical services delivery. About 1 in 5 doctors reported having some conflict with the laws of their employing institution. So much for the sanctity of the doctor-patient relationship, huh? Here's a clip:

So, for example, some religious hospitals stop their doctors from providing legal medical treatment, such as contraception, abortion, and certain end-of-life treatment options.

This poses a potential dilemma for healthcare providers. A recent survey, by Debra Stulberg, at the University of Chicago, and colleagues, set out to investigate.

They surveyed over 400 doctors, chosen at random [technical note: this wasn't a completely random sample. To make it statistically robust, they specifically set out to get more doctors with South Asian or Arabic surnames, and they adjusted the results to take this into account].

Just over 40% had worked at one time in a religious hospital. This was pretty evenly spread across age, religious affiliation (or none) and other demographics.

One in five of those who had worked in a religious hospital reported that their treatment decisions had at least sometimes come into conflict with hospital policy. In other words, 20% of doctors in religious hospitals have been prevented from prescribing what they believe to be the best treatment for their patients.

Women were twice as likely as men to have faced this problem (presumably because they are more likely to be dealing with female sexual health). And young doctors were more likely than older ones to have had conflicts with hospital policy.

Although you might expect non-religious doctors to be more likely to have problems with the ethics of religious hospitals, it turns out that they are not alone. As shown in the graph, Muslims and Hindus also had problems (contraception is allowed under Islamic law).

In fact, the differences between faiths were not statistically significant (although this may be because the survey was too small).

What did these doctors do when faced with a conflict? Well, almost without exception they complied with hospital policy and denied treatment to their patients.

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