Ah famous last words; the basis for the prestige of the entire medical profession. The Hippocratic Oath and the promise to put patient first and do no harm. But, how much harm can be done if we treat the patient reasonably well and make a few extra bucks on the side. After all, we all want to live like investment bankers no?
Well, unfortunately, the medical profession practices in Asia Pacific risks destroying this foundation of trust if it doesn’t proactively take steps to self-regulate its conflicts of interests.
According to Wikepedia…
Physician self-referral
Physician self-referral is the practice of a physician referring a patient to a medical facility in which he/she has a financial interest, be it ownership, investment, or a structured compensation arrangement. Critics of the practice allege an inherent conflict of interest, given the physician’s position to benefit from the referral. They suggest that such arrangements may encourage over-utilization of services, in turn driving up health care costs. In addition, they believe that it would create a captive referral system, which limits competition by other providers. (see physician self-referral)
Others respond to these concerns by stating that while problems exist, they are not widespread. Further, these observers contend that, in many cases, physician investors are responding to a demonstrated need which would otherwise not be met, particularly in a medically underserved area.
In the good ole U.S. of A, the response was the Stark Law named for United States congressman Pete Stark who sponsored the initial bill. Again, according to Wikepedia…
Legislation
Congress included a provision in the Omnibus Budget Reconciliation Act of 1989 (OBRA 1989) which barred self-referrals for clinical laboratory services under the Medicare program, effective January 1, 1992. This provision is known as “Stark I”. The law included a series of exceptions to the ban in order to accommodate legitimate business arrangements. A number of observers recommended extending the ban to other services and programs. The Omnibus Budget Reconciliation Act of 1993 (OBRA 1993) expanded the restriction to a range of additional health services and applied it to both Medicare and Medicaid; this legislation, known as “Stark II,” also contained clarifications and modifications to the exceptions in the original law. Minor technical corrections to these provisions were included in the Social Security Amendments of 1994.
Well through personal experience, I and most others are well aware that these conflicts of interests have not been addressed in Asia and although Asians in general still hold their venerable physicians in high regard, it is only a matter of time before this issue will need to be addressed. Usually the issue will be forced to the forefront when the payers (insurance companies and governments) start to realize the important utilization drivers and decide to do something about it. Unfortunately or fortunately, depending on perspective, the patients do not typically have the domain knowledge to know any better though access to healthcare information on the internet is changing this factor. If the doctor says you need it then you need it.
However, this misalignment of incentives, does drive the use of investigations and treatments which produce the highest margin for the physician rather than what is absolutely minimally necessary for the patient. Typically in the practice of medicine, minimally necessary is a good thing. This practice has driven the use of expensive new generation antibiotics at the expense of equally effective older generation antibiotics, thus stimulating resistant strains of bacteria to the newer generations. It also leads to false positives on investigations which submit patients to additional invasive testing that they may not necessarily require.
I don’t question the ethics and motives of our Asian physician colleagues, I simply wish for the profession to recognize the opportunity for abuse and the possibility that these misalignment in incentives will distort the practice of medicine and unnecessarily raise a question of trust for the patient who already is anxious visiting the physician and doesn’t want to be second guessing his doctor’s motives in ordering tests or prescribing drugs.
The question is how far do we go? click for IOM report
Tej Deol, M.D.
Even if it is subconscious ones, Its obvious there are conflicts of interest, everywhere. One of these conflicts is the financial interest. Other is “I may loose my patient trust if I don’t decide by myself, even if I have to cause redundant costs to do this”.
The second exists because:
1) Physicians still need to realize they are also humans – maybe special skilled ones, but still humans – whose decisions would be better for society if taken using others knowledge.
2) Common people need to understand that physicians are humans, so why would they know everything by themselves. So, there may be other possibilities before prescribing you expensive new drugs, or putting you five days in a hospital for a surgical procedure – I know a guy who discovered there would be alternatives for his three spinal surgeries: too late, he is now financially broken and 3 years incapable of working…
The financial conflict will be solved if the healthcare sector, including Physicians, start to be paid by effective results, comparing to best practices.
Fleury Group, in Brasil, searchs for a better society, in terms of ethics, health results and financial effectiveness. For example, our specialists are worried in solving problems, helping to diagnosis for cure. “Chronic Diseases Management” and “Health Prevention” are proofs it is possible to think about more health with less money for the society.
less money for the society.
[...] relationships and conflicts of interests. I have also spoke to this effect in my article “What conflicts of interest? Trust me – I’m a doctor.” addressing what I think is a urgent need for Asian physicians and their unions, oops I mean [...]