ETHICS, CONFLICTS AND ANCILLARY SERVICES OF PHYSICIANS
"Man is an animal with primary instincts of survival.
Consequently, his ingenuity has developed first and his soul
afterwards. Thus, the progress of science is far ahead
of man's ethical behavior."
- Sir Charles Spencer (Charlie) Chaplin
Many physicians see an inherent conflict of interest in providing ancillary services such as medical devices, specialty hospitals and the dispensing of medications. Those physicians are correct. They are, in fact, conflicts. And so, one might add, are the following: scheduling office visits; ordering X-rays, blood tests, urine tests, hospital stays or surgery; or any other act in the medical profession for which a physician gets compensated. Conflicts are a basic part of everyday life, including such a simple conflict as whether or not to stay in bed an extra ten minutes and risk being late to work. Conflicts only become problems when the resolution of the conflict is done improperly. That is the ethical part. That part comes from the soul of a person. Legislation cannot create ethical behavior; indeed, our legislators are not necessarily ethical.
Perhaps one should consider what a professional license is, be it that of a physician, lawyer, engineer or barber. A professional license is a permit granted to a person who has a very special set of knowledge and skills. This permit allows them to provide advice, touch another person physically, deal with another person's assets and income, or build something on which another person relies, possibly at risk of life and limb, and profit from the act. In all of these cases, people rely on that professional to demonstrate the skills and knowledge implied by the license. We learn very quickly that the professional judgement of that person is often critical to our success, and, in reality, is usually the primary basis for our decision to move forward.
To be pure, that professional judgement must be devoid of consideration for any personal economic or emotional benefit to the professional. This requires a deliberate act on the part of the professional and often runs contrary to human nature. In the case of our health care, we have entrusted that ethical responsibility to our physician. We expect our physician to charge for the professional judgement and all services provided. Ancillary products and services are simply other items for which our physician is entitled to a fee. Those acts are in no way an adverse reflection on our physician's ethics. Considering the lower cost, greater convenience, greater compliance and better health care often resulting for the patient or the payer, these services are more likely positive statements about that professional's ethics.
It was the incentive to earn a profit from individual services, be it in the form of wages or earnings from an enterprise that built this country. As government has gotten larger and larger, the vehicles which create the taxes for government to spend and overspend (i.e. profits and earnings) are attacked, more and more.
Plain and simply, these are "turf wars". Such policies as community ratings distort reimbursement and capitalism moves in and creates a competitive product at a lower cost. This may alter bureaucratic objectives and alleging "unethical behavior" can be used as a weapon (not only by the government but also other institutions). Staff privileges can be used as a weapon. Walk-in clinics in pharmacies counter physician dispensing. Self-righteousness removed, the simple issue is who gets the profits, taxes and the benefits of any savings. All parties can engage in this process and deal with these conflicts ethically. The process itself is not inherently unethical. It is good.