Wednesday, October 17, 2007

More than Pens and Pizza

Reduced salaries, perceived diminished social status due to the entry of minorities, foreign trained doctors, and women into the field, lack of autonomy due to increased oversight by insurance companies and corporate health care cost containment initiatives. Who wouldn’t blame a physician from seeking a little extra compensation on the side whether a free lunch or vacation from a fawning pharmaceutical rep? Besides, when else are they going to have time to learn about drug X’s off-label uses?

I’m kidding, of course. It’s wrong and we should not permit gifts (large or small) to physicians by pharmaceutical companies and I support Stanford’s recent decision to ban such things. Yet, I find the simple solution of “let’s ban the pens and food along with the vacations and lucrative consulting fees” na├»ve and not recognizing the bigger problem of the weakening of physicians’ duty to keep their patient’s health primary.

The WJS recently did a series of articles on two disturbing trends. One described how more and more physicians have a financial interest in the laboratories they refer patients to for tests. The other is on the trend of primary care physicians offering services such as Botox and liposuction that have nothing to do with a patient’s health but everything to do with the physician’s bottom line.

These practices undermine patients' confidence in their doctors to have their best interests as a top priority. Now that is a moral dilemma bioethicists need to speak out against, not just pens and pizza.

Excerpts from the WSJ articles cited:

Medicare Moves to Cut 
'Self Referral' Practice
Proposed New Rules Target The Rise in Doctors Sending Patients to Centers They Own
By DAVID ARMSTRONG
WJS September 12, 2007; Page B1

In recent years, many physicians have become wealthy by investing in magnetic resonance imaging, or MRI, facilities, surgery centers and diagnostic sites -- and then sending their patients to them. A recent McKinsey & Co. study pegged doctors' profits from this practice, known as self-referral, at $8 billion a year. Critics say self-referral fuels the ordering of unnecessary exams or procedures as the doctors stand to profit from the increased business. Supporters say that doctors' investment in new facilities improves medical services, especially outside metropolitan areas, where patients might not otherwise be able to access the latest technologies.

Small Firms Are Taking
On Second Jobs: FranchisesAdd-On Business Fills
Gap During Slow TimesAnd Expands Clientele
By RAYMUND FLANDEZ
WJS October 16, 2007; Page B5

Brian Fox wanted to give his general-practice clinic, Fox Medical Center, a face lift by providing additional services to patients. So he added a scaled-down version of a Dermacare Laser & Skin Care Clinics franchise. Patients can make regular medical appointments as well as schedule treatments like Botox, laser hair removal and skin resurfacing. He says the franchise brings in about $35,000 to $60,000 per month, on average doubling his monthly intake. There's little new overhead or inconvenience since Dr. Fox and his staff use the same exam rooms for laser and injectable services and medical examinations."The benefit that I've been able to develop out of this is not just from the financial end," Dr. Fox says. He says he finds the Dermacare procedures fun and a break from attending to sick patients or dealing with insurance companies.

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