Pros and cons: the eye of the beholder.
"Ethics" is a bit like "beauty" ... defined by the individual. What might be clearly unethical in my opinion would be dismissed by others as normal business practice.
Conflicts of interest are everywhere and cannot be completely avoided. Disclosure is the crucial antidote.
These behaviors are often not black or white. The problem is what to do about the shades of gray.
(An ethical concern is) physicians lying in order to get a service or procedure approved by an HMO/insurance company.
(An ethical concern is) physicians being caught in the middle of providing good (necessary) care, but only able to do so if they "break the law" with coding or insurance to make the care affordable.
The legal profession ... rewards unethical behavior.
We need to develop model rules of ethical behavior in health care and the business of health care as did the legal community with the model disciplinary rules.
Pharmaceutical representatives have become pushy to an unseemly degree. They think their role is to educate us, which I find offensive. They are promoting products, everyone knows that and we should drop the education charade.
Vendor-sponsored medical education, if balanced, can be highly informative and beneficial.... Of course I don't want promotional pitches but as someone who does vendor-sponsored medical education, I work very hard to maintain balance. All vendor-sponsored education is not promotional.
Compensation and perks from vendors
I do not find having lunch a problem. I don't think getting paid for having a discussion about a new medication is inappropriate. That may be just me, but I am not swayed by any of this. I prescribe almost all generics, unless they have failed. I do not give out free samples of any medication in my office unless a patient has no insurance. This may occur once a month at most.
Heavy detailing by pharmaceutical companies and device manufacturers at national medical meetings (is unethical). The attitude of physicians that pens, pencils, notepads, etc. are free (is unethical)! I observe my colleagues leaving exhibit halls with bags stuffed. This costs someone and it eventually costs our patients.
(An unethical practice that concerns me is) on-call specialists refusing to cover ER requests for assistance with poor patients.
Some business decisions ... may raise question of physicians as healers in the community, but are nonetheless based on reasonable financial considerations (e.g. declining call for patients that lack insurance). Although it is unfortunate that some individuals are denied care because of their financial and insurance status, I disagree with labeling such decisions as "unethical business practices" because there is no clear point when refusal to provide care becomes unethical. Is it unethical in an emergency? Is it unethical in a non-emergency? There is too much gray zone in this matter.
Business ethics is not generally taught to doctors, we do not generally spend much time talking about it in our professional organizations, many doctors do not understand it, and we do not enforce it. With those flaws, I see a lot of tendency toward conflicts of interest, undue influence, and outright fraud and abuse. I don't know if it can be curbed without state and federal intervention, as we have seen in the accounting and financial professions in recent years.
If we physicians do not do something about unethical practices by physicians and non-physicians alike, we will deserve the government to step in.
Instruction in ethics
Perhaps the medical schools should point this (ethics) out in their curriculum and practice.
Teaching ethics is a waste of time, since there is no proven correlation between knowledge of certain morals and behavior.
Health care is probably the least unethical industry/profession compared to other professions!
Physicians are held to a standard unparalleled in any business or political endeavor.
The abuse AGAINST doctors is much greater than the abuse that doctors do. You are focusing on the WRONG SIDE of the equation.
Thank you for taking the initiative in looking at this issue.
I am most concerned that the ACPE is joining the cacophony of restrictions on physician behavior. Please stop.
I'm glad to see some concern about this ... If we won't act as professionals, we can't expect the public to treat us as professionals.... Thanks for the opportunity to vent.
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|Date:||Mar 1, 2005|
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