Despite the terrorist attacks of September 11, the anthrax mailings, widespread media coverage and a proliferation of programs to teach physicians about bioterrorist agents, a survey conducted in early 2002 by University of Chicago researchers and published in the September 9, 2003, issue of Health Affairs, found that most doctors did not believe they or their practice were well prepared.
"Two years later we really aren't where we ought to be in terms of readiness to handle the next bioterrorism event, whatever that may be," said co-author Matthew Wynia, M.D., associate professor of medicine at the University of Chicago and director of the American Medical Association's Institute for Ethics. "The good news is that physicians are learning more about this and most are willing to help out. The bad news is that, despite this, they don't yet know what their role is and where they fit in the disaster response system."
The researchers were just as troubled by the 20 percent who were unwilling as by the 80 percent who were unprepared.
"Doctors have a moral obligation to care for the sick," said co-author Caleb Alexander, M.D., an instructor in clinical medicine and associate faculty at the MacLean Center for Clinical Medical Ethics at the University of Chicago.
Risk has traditionally been part of medical care and there have long been statements in professional codes of ethics supporting the duty to treat, yet only 55 percent of the surveyed doctors agreed that physicians have an obligation to care for patients in epidemics even if doing so endangers the physician's health.
Fewer physicians reported a willingness to treat as the authors described scenarios of increased personal risk. Although 80 percent were willing to treat patients with an "unknown but potentially deadly illness," that fell to 40 percent when the question involved a risk of "contracting a deadly illness." It dropped to 33 percent when the virus was specified as smallpox and it was stipulated that the physicians had not first been vaccinated.
Physicians in primary care were more likely to report willingness to treat, as were those who felt well prepared and those who saw it as a professional duty.
"Given the complexities of learning about bioterrorism, the perceived low likelihood of a local attack, and the many competing priorities facing doctors, it might be unrealistic to expect most physicians to learn how to detect and treat even the most likely bioterror agents," noted the authors. "Efforts to strengthen the public health infrastructure and ensure that all physicians understand their role in the emergency response system may be equally important ways of fostering preparedness."
"Furthermore," Alexander added, "this is an opportunity for physicians to rearticulate and reaffirm long-standing ethical principles regarding the duty to treat."
The research was supported by the Institute for Ethics at the AMA and the Robert Wood Johnson Foundation Clinical Scholars Program.