{"id":1017,"date":"2015-05-02T15:54:59","date_gmt":"2015-05-02T22:54:59","guid":{"rendered":"http:\/\/blog.stevenreidbordmd.com\/?p=1017"},"modified":"2015-05-03T17:30:02","modified_gmt":"2015-05-04T00:30:02","slug":"the-higher-ethical-standard-of-physicians","status":"publish","type":"post","link":"http:\/\/blog.stevenreidbordmd.com\/?p=1017","title":{"rendered":"Medical ethics are healthier than business ethics"},"content":{"rendered":"

\"ethics_meter\"<\/a>Compared to most others in society, physicians endorse, and are held to, higher ethical standards.\u00a0\u00a0(To illustrate, here are ethical codes from\u00a0the\u00a0AMA<\/a>\u00a0and\u00a0the World Medical Association<\/a>.) \u00a0High standards apply to\u00a0professionals in other fields as well, especially fiduciaries such as attorneys, accountants, schoolteachers, and judges. \u00a0But standards of medical\u00a0ethics may be\u00a0among the most stringent. \u00a0We put patient\u00a0welfare first, and anything that interferes with this primary aim, particularly personal gain, is deemed a conflict of interest (COI). \u00a0For example, it is legitimate to make money as a physician, i.e., to earn a living, but not in any way that detracts from\u00a0patient welfare. \u00a0These are not black and white distinctions, however, and line-drawing controversies abound. \u00a0Offering unneeded treatment solely to boost income is always\u00a0unethical. \u00a0But what about limiting one’s practice in\u00a0lucrative or otherwise pleasant ways: orthopedic surgeons practicing in ski towns, plastic surgeons who only do cosmetic surgery? \u00a0What about choosing a more lucrative specialty in the first place? \u00a0Accepting only certain types of insurance<\/a>, or none at all? \u00a0Charging<\/a> for missed or late-cancelled sessions? \u00a0Without attempting to resolve any of these examples here, it’s noteworthy how much concern is voiced, and ink spilled, over how physicians practice. \u00a0To completely escape controversy, we’d have to take a vow of poverty and offer our services for free.<\/p>\n

In contrast, many other businesses that affect\u00a0health do not share the physician’s ethics. \u00a0Precise line-drawing plainly doesn’t apply. \u00a0Beverage companies peddle\u00a0diabetes along with refreshment, supplements come adorned with dubious health claims. Snack food can\u00a0be unhealthy. \u00a0Manufacturers and retailers of exercise equipment need not\u00a0refer customers\u00a0to more suitable products from competitors. \u00a0 One can\u00a0even argue that new cars, not to mention video games, movies, and many other products, discourage people from exercising. \u00a0“Patient welfare” simply isn’t a priority for most\u00a0firms\u00a0\u2014\u00a0they aren’t dealing with patients. \u00a0There is no general code of business ethics that makes\u00a0health its primary aim. \u00a0Thus, in extreme cases\u00a0the government \u2014 we the people \u2014 step in, by limiting tobacco and alcohol ads for example, or by inspecting meat. \u00a0This is one reason we have government: to set priorities, including ethical priorities, that an ungoverned\u00a0free market cannot or will not.<\/p>\n

Some firms do explicitly deal with patients, yet still do not share the physician’s ethical standards. \u00a0Insurance companies run feel-good ads that obscure their cost-containment mandate. \u00a0Medical corporations attract customers or subscribers who are “covered lives” as opposed to individual patients. \u00a0Pharmaceutical companies\u00a0entice\u00a0the public with all the irrational tricks used to sell\u00a0other products, then\u00a0tack on\u00a0“ask your doctor” to absolve themselves\u00a0of any medical responsibility. \u00a0Pharmacy benefit managers (PBMs) can disallow\u00a0a physician’s prescription wholly on the basis of cost, and without taking medical responsibility. \u00a0These are all huge “conflicts of interest” from a physician’s<\/a> point of view. But COI doesn’t apply the same way to entities with less stringent professional ethics, where the primary aim is profit, not health.<\/p>\n

This makes our burden harder. For the most part, it isn’t up to pharmaceutical companies to avoid biasing doctors\u00a0with their promotional efforts. It’s up to us. \u00a0Moreover, it’s up to us to counter unhealthy biases instilled in the public, like the\u00a0willingness to use an antipsychotic<\/a> with significant side-effects to treat routine depression. \u00a0Likewise, as long as insurers and\u00a0PBMs are corporations,\u00a0no one will compel\u00a0them through moral persuasion or ethical codes to sideline their economic interests. It’s not a conflict\u00a0for a business to maximize return for its shareholders; it’s the main\u00a0reason they exist. Indeed, too much\u00a0concern for patient welfare might be criticized, e.g., at a shareholder meeting, as a COI that impedes this primary aim.<\/p>\n

Doctors are held to standards that would be absurd in virtually any other business. Historically,\u00a0these higher ethical standards gave us a special status in society, and earned\u00a0our patients’ trust. The erosion of this special status<\/a>, and of patient trust<\/a>, is both a cause and an effect of a health care environment\u00a0with lower, more businesslike, ethical standards. \u00a0The accelerating corporatization of American medicine replaces traditional medical ethics with the looser standard of business ethics.\u00a0 MD decisions are now\u00a0vetoed by MBAs. \u00a0As a result, patients may\u00a0see us as replaceable technicians in a corporate infrastructure, and lose the benefits of a personal physician. \u00a0In parallel, physicians who are\u00a0viewed\u00a0by their patients and employers as mere cogs in the wheel\u00a0of a large system are more apt to relax their own high ethical standards.\u00a0 I fear for both our profession and the public as this vicious cycle\u00a0continues.<\/p>\n

While we\u00a0doctors are\u00a0busy maintaining our ethics and watching out for COI, other “stakeholders” in health care operate\u00a0under\u00a0fewer ethical\u00a0constraints and enjoy greater profits, often directly at our expense. \u00a0It\u00a0can be\u00a0maddening, yet physicians\u00a0have no unified voice to defend ourselves and our work. \u00a0Proposed solutions are inescapably\u00a0political, and polarize us along deeply divided political lines, left versus right. \u00a0Ultimately, though, traditional medical ethics\u00a0and public welfare are on the same side. \u00a0Doctors exist to help individual patients \u2014 and we will all be individual patients someday. \u00a0The looming\u00a0challenge is whether we can put our internecine struggles aside long enough to save ourselves, our families, and our neighbors.<\/p>\n

Image courtesy of Stuart Miles\u00a0at FreeDigitalPhotos.net<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Compared to most others in society, physicians endorse, and are held to, higher ethical standards. (To illustrate, here are ethical codes from the AMA and the World Medical Association.) High standards apply to professionals in other fields as well, especially fiduciaries such as attorneys, accountants, schoolteachers, and judges. But standards of medical ethics may be […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[67],"tags":[68,13],"class_list":["post-1017","post","type-post","status-publish","format-standard","hentry","category-medical-practice","tag-conflicts-of-interest","tag-ethics","odd"],"aioseo_notices":[],"_links":{"self":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1017","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1017"}],"version-history":[{"count":8,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1017\/revisions"}],"predecessor-version":[{"id":1027,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1017\/revisions\/1027"}],"wp:attachment":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1017"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1017"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1017"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}