Despite rules, "in-office dispensing is a form of implicit coercion"

LETTER — Posted Nov. 13, 2006

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Regarding "Office-based sales hinge on the patient's best interests" (Column, Oct. 2): Office-based dispensing to patients is wrong, and its widespread practice does not alter an inherent conflict of interest.

As physicians, we are afforded unique and special privileges in society. We are trusted always to consider our patients' needs first regardless of any financial interests. Dispensing products at a double or triple markup is suspect, especially given the lack of rigorous evidence-based studies demonstrating superiority against over-the-counter products.

Ethics Forum commentator Michael H. Gold, MD, of Nashville, Tenn., notes that the American Medical Association's Code of Ethics permits sales of health-related products when the patient is not coerced. However, our relationships with patients are not equal. In-office dispensing is a form of implicit coercion, given the position we enjoy in society.

Patients assume that a product must be superior, given its placement in our offices. The exploitation of this assumption for financial gain is a blatant violation of our duty to act in the best interests of our patients. We were all physicians before we were business owners.

In an age of managed care and declining reimbursements, financial pressures have led to a creative interpretation of ethical practices. If we continue to behave in this manner, and if we continue to permit midlevel practitioners to see our patients with minimal to no oversight, then I fear that our profession will suffer irreparable harm. In the end, however, patients will suffer most.

Peter A. Klein, MD, Stony Brook, N.Y.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2006/11/13/edlt1113.htm.

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