Ethical challenges abound.Here's a list of some of the specific unethical--or potentially unethical--practices cited by ACPE ACPE Accreditation Council for Pharmacy Education ACPE American Council on Pharmaceutical Education ACPE American College of Physician Executives ACPE Association for Clinical Pastoral Education, Inc. survey respondents * Allowing patients who are breastfeeding or planning to breastfeed breast·feed or breast-feed v. breast-fed , breast-feed·ing, breast-feeds v.tr. To feed (a baby) mother's milk from the breast; suckle. v.intr. To breastfeed a baby. to be approached by formula companies. * Refusing Medicaid, CHAMPUS CHAMPUS Civilian Health & Medical Program for Uniformed Services A health care plan for military dependents and retirees operated by the DoD Types of service HMO, PPO, and fee-for-service, through a single health plan known as TriCare , or any other government or non-government insurance. * Over-coding to increase income. (Really, does the family history change between each office visit?) * Medical specialty medical specialty Any specialty that provides non-interventional Pt management, ie with drugs, or with minimum intervention–eg, balloon catheterization Examples Internal medicine–allergy and immunology, cardiology, gastroenterology, hematology/oncology, societies promoting retesting and education to increase revenues. * Coding seminars that promote ways to get the most money per procedure and procedures that get the most money. * Specialists who approach competitors' patients who are hospitalized and ask them to change physcians. * The current practice in academic medicine to perform "studies" funded by companies in which the results seem to ALWAYS show a benefit for the company's product. Glaring example is the defibrillators in cardiology that have boomed because of a study designed and funded by the defibrillator defibrillator, device that delivers an electrical shock to the heart in order to stop certain forms of rapid heart rhythm disturbances (arrhythmias). The shock changes a fibrillation to an organized rhythm or changes a very rapid and ineffective cardiac rhythm to a manufacturer. Clinical practice stems from this research, which is blatantly questionable. * Hospitals and health plans putting pressure on physicians to cut length of stays and avoid necessary tests to cut the cost. * Officers of the corporation signing contracts with vendors, then resigning and working for the vendor. * Pathologists agreeing to open up a lab in the physician's office so that the physician can collect technical fees for pathology when the bulk of the work is done by the pathologists. This is happening in cytopathology and anatomic pathology in deals with urologists and dermatologists. [ILLUSTRATION OMITTED] * Physicians who sign up for CME CME See: Chicago Mercantile Exchange CME See Chicago Mercantile Exchange (CME). and do not attend. This is especially evident at out-of-town programs with the lure of sightseeing, golf, shopping, etc. * Office and hospital staff using sample meds for their personal use. * Doctors who alter the patient's procedure to fit investigational protocols they have underway. * Not-for-profit institutions fraudulently stating amount of community benefit to maintain not-for-profit status. * Physician ownership of stock in pharmaceutical companies. It would be very challenging for a physician not to be influenced by stock ownership. Physicians should fully disclose any financial relationships that have the potential to influence their recommendations, including ownership of pharmaceutical stocks. I'm not aware it's even been studied. RELATED ARTICLE: Personal Insights and Experiences with Unethical Behavior --Collected comments from respondents to ACPE's Ethical Behavior Survey [ILLUSTRATION OMITTED] I unfortunately have numerous examples that I have seen over the years of practice. I see consultant physicians renting space from primary care physicians to obtain a referral source. I see physicians dictating template notes that are totally false to allow procedures. I have seen capitated physicians throw positive stools for occult blood occult blood n. Blood that is present in amounts too small to be seen and can be detected only by chemical analysis or microscopic examination. Occult blood Presence of blood that cannot be seen with the naked eye. in the garbage to avoid the cost of a colonoscopy and missing cancers that could have been diagnosed earlier. I observed the CEO (1) (Chief Executive Officer) The highest individual in command of an organization. Typically the president of the company, the CEO reports to the Chairman of the Board. , CFO See Chief Financial Officer. and COO conspire con·spire v. con·spired, con·spir·ing, con·spires v.intr. 1. To plan together secretly to commit an illegal or wrongful act or accomplish a legal purpose through illegal action. 2. to conceal the actual financial performance from the board.... The new board has no idea what is going on. The house of cards house of cards n. pl. houses of cards A flimsy structure, arrangement, or situation that is in danger of collapsing or failing: "The collapse of the rupiah . . . will fall one day. I witnessed many examples of fraud by this same non-physician CEO. He proudly displays regional and national awards received for clinical and financial accomplishments that he and his organization never really accomplished. The competition cannot figure out how they do it. Simple, make it up and go for it. No one ever catches on. The awards just keep coming. I've seen some egregious cases. Some docs actually have people paid to come in and take an exam so Medicare and/or Medicaid will pay, and the recruiters tell the patients what symptoms to say they are having. Board members are brought on to represent the community, yet work for or own a business that has contracts with the hospital. We try to use local vendors to keep some of the money in the community, but how can one take care of the ethical conflict of interest, especially when the board sees these individuals as the experts in that field? |
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