Business ethics of private general practitioners in KwaDukuza, KwaZulu-Natal

BACKGROUND: Private general practitioners (GPs) have been criticised by the lay press citing unethical practice and the acceptance of kickbacks. In 2003, the Ethics Institute of South Africa conducted a national study of all doctors and also accused private GPs of unethical practice. In countries such as South Africa, with a practice of fee-for-service payments, there may be a temptation to put material interests above the best interests of patients. Private GPs, on the other hand, are of the opinion that the press and the Ethics Institute publication have unfairly singled them out. OBJECTIVE: To detect whether private GPs in KwaDukuza perceive their colleagues to be practising ethically. METHOD: The study entailed a cross-sectional descriptive study design, in which all 30 private GPs based in KwaDukuza, KwaZulu-Natal, were asked to complete a self-administered questionnaire during 2003. The survey was done on a voluntary basis and anonymity and confidentiality was maintained. RESULTS: Twenty-five doctors returned completed questionnaires (an 83.3% response rate). Seventy per cent perceived their peers to be practicing ethically, while 48% (12/25) reported that they did not observe any medical misconduct by their colleagues. The majority of the respondents (76%) reported that they did not know of any colleague who supplemented his or her income through the over-servicing of patients. The majority of the respondents (84%) also reported that their colleagues never accepted cash payments that were not declared for income tax purposes. Medically unnecessary tests are a form of unethical behaviour pertaining to over-servicing, and 64% of the respondents reported that medically unnecessary tests to satisfy patient requests were not an important reason for performing these tests. The doctors expressed high stress levels from multiple stressors in their occupation. CONCLUSION: GPs in KwaDukuza indicated that they were under stress, but still practised ethically. The GPs emphasised the need for more training in medical ethics at all levels of the medical career. The majority of GPs of KwaDukuza perceive their colleagues to be practising ethically.