HbhbhModule_4_6_Ethics_Doctor_Industry.pptx

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1. Module 4.6: Case Studies in Ethics and the Doctor-Industry Relationship Professional Year 4 | Duration: 5 Hours | AETCOM Module 4.6 Dr.Pradeepa.G M.S.Ortho. Senior Resident SSIMSRC, Davangere.

2. Background and Competency Addressed This module explores nuances in professional relationships and conflicts of interest. Competency (SH): Identify conflicts of interest in patient care and professional relationships and describe the correct response.

3. Learning Experience Structure Year: Professional Year 4 Total Hours: 5 - Introduction of case: 1 hour - Self-directed learning: 2 hours - Anchoring lecture: 1 hour - Discussion and closure: 1 hour

4. You get a call from the secretary of the promoter of the largest and most successful corporate hospital in the city asking for an appointment for you with him. You are perplexed but make it to the appointment. You enter a large well appointed room. The owner of the hospital gets up from his chair, welcomes you and asks you to sit down. “Welcome to our hospital, doctor.” After a few minutes of empty banter, he says – “My marketing executives tell me that you are the most successful practitioner in this area. As you know, we are a growing organisation; we are eager to partner with you. Doctor, I know that you use the services of another hospital here but we can make it worth your while to consider”. Case Study: The Offer

5. You look enquiringly. He continues. “In addition to your professional charges that you can determine, we can provide you with 20% of the hospital’s collections from your patient including radiology and laboratory charges. If you send us your outpatients for consultations, laboratory or radiology we will give you back 30% of our collections. We hope that you will consider this, doctor and become part of our extended family.”

6. Case Study: The Offer A prominent hospital owner offers you 20-30% kickbacks for referring patients to their facility. While flattering, this offer presents serious ethical dilemmas regarding conflict of interest and professional conduct.

7. 1. Fee Splitting and Its Implications Definition: Sharing of professional fees or earnings with non-practitioners or for referrals. Unethical and legally questionable practice. Compromises clinical judgment and patient trust. Against MCI/NMC regulations and professional codes of conduct.

8. 1. Definition and Forms of Fee Splitting Fee splitting refers to the practice where a physician receives a monetary reward or kickback from another service provider (hospital, lab, pharmacy) in exchange for referring a patient. It can be: Explicit: As in this case, a defined percentage offered per referral. Implicit: Gifts, commissions, favors, or luxury incentives. Direct or indirect: Through payments, shares, or other financial gains.

9. 2. Why is Fee Splitting Unethical? I t compromises clinical judgment: The doctor may choose a facility based on profit rather than patient welfare. Destroys trust: Patients assume doctors act in their best interest; hidden financial incentives violate that trust. Increases cost to patients: Referral-based incentives often lead to unnecessary investigations or hospital admissions. Contradicts medical professionalism: Medical codes of ethics emphasize altruism, not commercialism.

10. 3. Regulatory and Legal Perspective National Medical Commission (NMC) and former MCI guidelines prohibit fee splitting. Considered professional misconduct; may lead to suspension, cancellation of license, or disciplinary action. Violates principles in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002. 4. Impact on the Doctor–Industry Relationship Encourages a transactional model of care. Creates a dependency on corporate pressure and marketing over clinical autonomy. May deter evidence-based practice in favor of profit-driven services.

11. 2. Can Doctors Become Entrepreneurs? Yes, but must maintain ethical boundaries. Entrepreneurship in diagnostics, hospitals, or tech is common. Clear separation between business interests and clinical care is crucial.

12. 1. Can Doctors Be Entrepreneurs? ✅ Yes – within ethical limits 1. Doctors can ethically engage in entrepreneurial activities such as: Establishing hospitals, clinics, diagnostic labs Founding health-tech startups (telemedicine, AI in diagnostics) Creating medical devices or innovations Writing health books, creating apps, consulting 💡 The key is separation of clinical judgment from business incentives.

13. 3. Doctor–Industry Relationship Risks Referral bias: Entrepreneurial interest may lead to unnecessary tests or admissions. Conflict of interest: Dual roles (care provider + business owner) can blur priorities. Loss of objectivity: Financial success may compromise evidence-based treatment. Public trust erosion: Patients may view doctors as businesspeople, not healers. 4. Legal and Regulatory Framework Doctors can own medical establishments, but must not: Demand kickbacks (fee-splitting) Refer unnecessarily to own institutions Mislead patients for financial gain NMC Code of Ethics: Doctors must not allow profit motives to influence clinical decisions.

14. 3. Can Doctors Own Pharmacies or Pharma Stocks? Allowed legally, but potential for conflict exists. Ethical concerns if prescriptions are influenced. Transparency and disclosure are essential. Avoid self-referrals where financial interests exist.

15. 4. What Comprises Professional Conflict of Interest? When personal, financial, or other interests compromise professional judgment. Examples: Fee splitting, biased referrals, pharma sponsorships. Must disclose and avoid where possible. Ethical responsibility to put patients first.

16. 🧾 Evaluation Criteria for Conflict of Interest in Doctor–Industry Relationship Proportionality Transparency Fairness Accountability Non-exploitation Professional integrity Perception of bias Frequency/Intensity

17. How to Solve Conflict of Interest in Doctor–Industry Relationship

18. Assessment Overview Formative: 1. Active participation during discussions and lectures. Summative: 1. Fee splitting and its implications for patient care. 2. Conflicts in professional relationships. 3. Emphasis on critical thinking and ethical reasoning.

19. Summary and Takeaway Uphold professional ethics at all times. Avoid any form of fee splitting or unethical financial arrangements. Transparency and integrity are key pillars of medical professionalism. Always prioritize patient welfare above personal gains.