Moral beliefs guide doctors' decisions during ethical dilemmas

January 1, 2011

Recently, a 78-year-old woman for whom I had cared in the past returned with a complaint of numerous growths on her neck. I informed the patient that I would be happy to remove her skin tags, but there was no medical indication to do so. The treatment would not be an insurance-covered service. She was not at all happy about this response.

Key Points

Examination revealed at least 10 small skin tags and seborrheic keratoses. I informed her that I would be happy to remove these spots, but there was no medical indication to do so and removal would be for cosmetic purposes only. Therefore, the treatment would not be an insurance-covered service.

She was not at all happy about this response and tried to convince me to change my thinking about the need for removal. She used three different strategies, one after the other. I will try to paraphrase her remarks:

Two days later, the patient's daughter phoned and tried a fourth strategy, the one that was probably most annoying. She stated unequivocally that her mother had many friends and would not hesitate to tell them about the shoddy service she received in my office and what a money-grubbing person I was for not returning her copay. I generally respond to threats and intimidation very poorly; I essentially hung up on her.