Physician executives worry about lapses in medical ethics
■ While most survey respondents said they were concerned about unethical practices, most said such practices didn't occur in their own organizations.
By Damon Adams — Posted March 28, 2005
A new survey shows that nine in 10 physician executives are "very concerned" or "moderately concerned" that unethical business practices are impacting U.S. health care.
The nationwide survey of about 1,500 physician leaders found that executives were most worried about doctors refusing to accept call on patients with no insurance, influence by pharmaceutical firms and medical device manufacturers, and overtreatment of patients to boost income.
Although most physician executives in the survey voiced concerns about unethical practices, six in 10 said no physician in their organization was involved in unethical behavior. About half said they thought a health care organization in their community had unethical practices.
"We know this issue is out there in various forms, but the extent with which [physician executives] feel it is an issue is alarming," said Marvin Kolb, MD, president of the American College of Physician Executives, which published the survey in the March/April The Physician Executive.
Most physician groups and health care organizations have ethics codes and other policies that speak to conflicts of interest, accepting gifts from drug companies and other sensitive issues. In the past few years, some have taken additional steps to ensure that ethical standards are upheld.
In 2001, the American Medical Association conducted an educational campaign to remind doctors of guidelines approved in 1990 on industry gifts that said physicians should accept only gifts that have some benefit to patients, are of modest value and come with no strings attached.
In July 2002, the Pharmaceutical Research and Manufacturers of America set guidelines that forbid expensive dinners and frivolous gifts. Some states such as Vermont have legislation requiring drug company representatives to report gifts over a certain value that they give to doctors.
"[Drug companies] are greatly limited compared to what it used to be," said Donald Hofreuter, MD, chief executive officer of Wheeling Hospital in Wheeling, W.Va., and author of The Higher Ground, which discusses medical ethics.
Conflicts of interest cause worry
Many leaders believe most doctors do a good job of following ethical guidelines.
"Physicians are professionals with very high moral standards," said Michael Goldrich, MD, chair of the AMA Council on Ethical and Judicial Affairs. "There are areas in the [AMA Code of Medical Ethics] which address many of the areas of concern that the [physician executives survey] raises. Doctors do have the guidelines for the right things to do."
In a statement about the ACPE survey, AMA President John C. Nelson, MD, MPH, said, "The AMA believes the vast majority of physicians put the interests of patients first -- so in the rare instance when medical ethics are breached, it is reassuring to know that physician leaders share the AMA's concern."
When problems arise, respondents said the offenses most often involve physicians being influenced by drug companies to prescribe a certain drug, physicians overtreating patients to boost income and doctors refusing to accept call on patients with no insurance.
"The poor management of conflicts of interest poses a major threat to professionalism in medicine. Some of the things that are going on are very worrisome," said Laurence McCullough, PhD, professor of medical ethics at Baylor College of Medicine, who teaches an ACPE course on ethical challenges of physician executives.
About seven in 10 survey respondents said their organizations had a written code of ethical behavior that included disciplinary actions for ethics violations. About six in 10 said their ethics codes were enforced. But 81% of respondents said large professional organizations needed to promote tougher ethical standards.
"You can't maintain professional integrity alone anymore. You need the support of the organizational culture," Dr. McCullough said.