Just another line of alternative medical income. Physicians are simply responding to reimbursement pressures:
Pediatricians in Encino sell diaper cream for infants, umbilical-care swabs for newborns and bath soap for babies; dermatologists in Los Angeles peddle skin cleansers, moisturizers and sunscreens; and gynecologists in Beverly Hills sell nutritional supplements.Some physicians offer such products as a convenience for their patients or because they believe the products are superior to goods already on the market. Others are motivated, in large part, by financial gain. Whatever the reason, the sale of such goods raises ethical questions for doctors and a very practical question for patients: Should I buy what my doctor is trying to sell me?
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{ 6 comments }
Trying to blame greed on reimbursement “pressures” is a little much, Kevin, considering you have no idea how much the particular doctors make in the first place.
Not to say greed is bad at all. But these doctors are simply doing what many in the free market do – selling their clients a product.
You say you want the free market, then you cast ethical aspersions on all those who act how the market dictates you must act. For your financial gain.
Oddly, Kevin, you have no objection when doctors try to make more money by legislating their malpractice premiums, yet when they sell a product, you seem to consider it morally questionable. I would say it is your moral compass that is off.
I don’t believe I have ever explicitly stated that I objected to the practice of alternative medical income.
Thanks,
Kevin
It is normal business to pursue whatever “back-end” sales you can on each contact with the customer. This is a logical thing to do which any businessman would suggest–the problem is that the physcian, if ethical, is to recommend act in the patients interest, not primarily his own. Any other behavior undermines the doctor-patient relationship–and if common, confidence in the entire profession is lost.
The $24 dollar vaseline is clearly a rip off which would be acceptable business practice anywhere else but has no place in a medical practice. In general however, if priced fairly (I think fairly to both the doctor and patient), offering the things that people need to carry out your instructions is appropriate, many people procrastinate going to the drug store and you may have more adherence providing supplies in the office.
It should however be priced appropriately and not pushed or sold. I would suggest anything more than “We have some of that we can sell to you or you can stop at the drug store” is shilling.
I don’t think that it has to be sold at cost, the physicians other costs of labor and space are appropriately reimbursable. It shoud not be a profit center that gives him and incentive to push his products.
The selling of goods unrelated to the care provided is plainly unprofessional. (”Dr. Bob’s Urology and Golf Accessories”). The issue of selling prescription drugs in the doctors office has been controversial for more than a hundred years. I used to think I would never do it until I staggered into a doc-in-a-box much sicker than I knew with pneumonia–and have been ever grateful that I could get the prescriptions there as I could barely walk or drive.
With the centralized health record craze, more and more of my patients have expressed concern the record of their Prozac prescription being scattered all over the place from the pharmacy. Smart people know that this information can be used against them by insurance companies.
the problem is that the physcian, if ethical, is to recommend act in the patients interest, not primarily his own. Any other behavior undermines the doctor-patient relationship–and if common, confidence in the entire profession is lost.
What a load of crack!!! IT’s time for physicians to move past the old days. The only thing that undermines the MD-pt relationship is poor medical care. The AMA, and other agencies need to get off this outdated sacred cow of the broadly defined “ethics” of physicians and patients.
It’s a service, pure and simple. And to the purists, your a dying breed best kept sheltered or locked up in academic centers. The industry has changed, the players ahve changed, the mindset has changed. Move on.
“I don’t believe I have ever explicitly stated that I objected to the practice of alternative medical income.”
So then explicitly state your position, Kevin. The tone of your comments and the excerpts you publish implicitly indicate you are opposed. If that’s not your position, what is it?
“The only thing that undermines the MD-pt relationship is poor medical care.”
Recommending a product because is it more profitable to me rather than because it is best for my patient IS poor medical care. The physician’s obligation is to recommend the best treatment for his patient. The patient may make a different choice for a variety of reasons’s but the patients best interest must alway be paramont in the doctors mind.
That ethic is the core of what we profess in this “profession” and any who practice by a different principle are effectively commiting fraud by taking on the mantle of the profession and misleading the public. A doctor who can’t accept that basic principle has no business practicing medicine.
I have indeed moved on and taken the initiative to change the players that I play with. Tired of working in clinics directed by MBA “ethics” of profit being the only thing that mattered, and increasingly seduced into being an agent of insurance companies whether than my patients, I now practice pure fee-for-sercive medicine, make more money than I ever did, and am no where near any academic medical center–thiving in the free market.
Because some people still want a doctor who is their doctor, and are willing to pay for one.
If anyone want to redefine his job as primarily a business and run it just as he would a hair salon or car dealership–I am ok with that as long as he is honest and tells his patients that is what he is doing–and doesn’t falsely imply by silence, titles, and symbolism that he is practicing Hippocratic medicine.
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