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Ethical Scenario 9

You are a medical student in a GP surgery, shadowing one of the GP partners, who is also your supervisor. Your next patient is Mrs Collins, a 30 year old secretary who your supervisor states is a ‘typical hypochondriac…always coming in with new concerns, with no real medical problems’. Your GP supervisor advises you that placebo medications (sugar pills) are the best treatment for these patients, and ‘always do the trick’.
 
Outline the main issues raised.
Average Candidate Response
  • It appears that the GP is being judgemental and not taking the patient's symptoms seriously.
  • This case raises ethical issues, and it could be argued that the GP is acting unethically.
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​Excellent Candidate Response
There are two important sides to consider

  • On one hand, by effectively deceiving patients and giving them placebo medications rather than actual medications, you are undermining their autonomy.
  • Slippery slope argument: If this doctor is prepared to deceive this category of patients, they are likely to feel comfortable acting similarly towards other patients for example ‘self-inflicted conditions’ (eg. Smokers/alcoholics/sporting injuries).
  • Attempting to categorise patients (eg. ‘hypochondriacs’) may lead to missing more serious diagnosis, as you will consistently ignore potentially sinister red flag symptoms.
  • Should this doctor be practicing medicine, let alone training future medical professionals?
 
On the other hand, it may be argued:
  • Placebo medications (sugar pills) are likely to have fewer side effects than prescribing stronger alternative medications which are unlikely to be required, if there is no underlying medical condition.
  • With patients often reporting some benefit from placebo medications, you are fulfilling your duty of beneficence as a doctor.
  • This GP is effectively managing the patient with limited resources, hence not placing additional strain on the resource-stricken National Health Service.