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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
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40. Product Sales
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To the extent that they are a medical practitioner, the medical practitioner considers only the patient’s best interests in what they prescribe, not the medical practitioner’s good.
~ Plato
Compromised Care
The Mysterious Case of the Conflicted Practitioner
It was a chilly autumn morning in the small town of Springfield when Dr. Emily, a renowned physician in the community, was found dead in her office. The cause of death was determined to be an overdose of a commonly used pain medication. However, the circumstances leading up to her death raised many questions.
Dr. Emily was known for her impeccable patient care and her strong stance against any practices that conflicted with the patient’s best interests. Yet, it was discovered that she had been engaging in the sale of vitamins and cosmetics to her patients, which was in violation of the medical profession’s ethics code.
The investigation led by Detective Rodriguez uncovered a web of deceit and greed. It was revealed that Dr. Emily had been receiving kickbacks from the manufacturers of the products she was selling, leading to a financial conflict of interest that compromised her ability to provide unbiased care.
As the case unfolded, Detective Rodriguez educated the healthcare providers in the community about the dangers of product sales and the importance of upholding the patient-centered focus of the medical profession. The community was shocked to learn about the ethical implications of such practices and the potential harm it could cause to the patient-practitioner relationship.
Through the investigation, the healthcare providers in the community learned about the legal, professional, and ethical regulations surrounding product sales and the importance of maintaining public trust in the medical profession. They understood that the pursuit of profit should never come at the expense of the patient’s best interests.
In the end, Dr. Emily’s legacy was tarnished, but her death served as a wake-up call for the medical community to recommit to the patient-centered focus of their profession. The case of the conflicted practitioner reminded them that the medical profession is not a business for profit, but a patient-centered profession for the patient’s best interests, as emphasized by the great philosopher Plato.
Abstract
There is a tension between the capitalistic doctrine of “Caveat Emptor” (let the buyer beware) and the medical profession’s patient-centered maxim of “patient’s best interests.” The sale of products by medical practitioners is considered a conflict of interest and is regulated legally, professionally, and ethically as it threatens the patient-practitioner relationship and public trust in the medical profession. The medical profession is not a business for profit, but a patient-centered profession for the patient’s best interests. The American College of Physicians (ACP) Ethics Manual and the American Medical Association (AMA) Code of Medical Ethics highlight concerns about financial conflicts of interest, erosion of patient trust, and the ethical implications of product sales. The Physician Self-Referral Law (Stark law) prohibits practitioners from referring patients to receive designated health services payable by Medicare or Medicaid from entities with which the practitioner or an immediate family member has a financial relationship. The medical profession is socially permitted to exist as a lucrative profession in exchange for focusing on the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities.
**
Think
[40:1] There is a longstanding capitalistic doctrine in American contract law known as Caveat Emptor, Latin for “let the buyer beware.” This capitalistic contract is the antithesis of medicine’s patient-center maxim of “patient’s best interests.”
[40:2] Product sales or endorsements by a medical practitioner are considered a conflict of interest and therefore regulated legally, professionally, and ethically. Practitioners engaging in product sales threaten the patient-practitioner relationship and how society perceives and interacts with the medical profession.
[40:3] The medical profession is not a business meant for profit; rather, it is a patient-centered profession for the patient’s best interests.
Assess
Patient: 1) Autonomy
[40:4] Product sales to patients risk the erosion of the patient-practitioner relationship, which in turn erodes patient autonomy (informed consent). Patient’ informed consent is essential for authorizing the practitioner to provide treatment to the patient. For informed consent, the patient must trust the practitioner’s competence and information provided to be unbiased and appropriate. “Let the buyer beware” is incompatible with trust and unbiased treatment options.
[40:5] The American College of Physicians (ACP) Ethics Manual states:
The sale of products from the physician’s [practitioner’s] office might also be considered a form of self-referral and might negatively affect the trust necessary to sustain the patient-physician [practitioner] relationship.
[40:6] This is not an assessment against capitalism per se; rather, it is an assessment that capitalism within the patient-practitioner relationship is unprofessional and morally incompatible.
Practitioner: 2) Beneficence & 3) Nonmaleficence
[40:7] The medical practitioner’s professional prime directive is the patient-centered maxim: maximize the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities using the principles of beneficence (do good) and nonmaleficence (do no harm). Although product sales do not necessarily violate the principles of beneficence (do good) or nonmaleficence (do no harm), it does violate the patient-centered focus, thereby violating the trusting relationship.
[40:8] Adam Smith’s invisible hand argued that acting in one’s self-interest would result in the greater good for all society. Even if this were to be economically accurate, this is in total contradiction with the practitioner’s professional prime directive of altruistically pursuing the patient’s best interests, not the practitioner’s nor society’s best interests. The practitioner’s interests are vital and ought to be pursued, but within the context of the patient-practitioner social-contract, that is not part of the agreement.
[40:9] The American Medical Association (AMA) Code of Medical Ethics states:
Physician [Practitioner] sale of health-related products raises ethical concerns about financial conflict of interest, risks placing undue pressure on the patient, and threatens to erode patient trust, undermine the primary obligation of physicians [practitioners] to serve the interests of their patients before their own, and demean the profession of medicine. (9.6.4 Sale of Health-Related Products)
[40:10] If the medical practitioner is making products available that are necessary for providing the medical standards of care but are not readily available, and without any financial gain, such as crutches, then doing so is legally, professionally, and morally accepted. Selling to patients readily available items such as vitamins and cosmetics is not acceptable.
[40:11] The American College of Physicians (ACP) Ethics Manual states:
Most products should not be sold in the office unless the products are specifically relevant to the patient’s care, offer a clear benefit based on adequate clinical evidence, and meet an urgent need of the patient.
Public Policy: 4) Justice
[40:12] Numerous states have laws that prohibit the:
promotion of the sale of drugs, devices, appliances, or goods provided for a patient in such a manner as to exploit the patient for the financial gain of the physician [practitioner]. (Illinois Law 225ILCS22)
[40:13] Federal and state governments are interested in protecting their citizens from unscrupulous practitioners who take advantage of their social standing and patient vulnerability.
[40:14] The American College of Physicians (ACP) Ethics Manual states:
The sale of products from the physician’s [practitioner’s] office might also be considered a form of self-referral.
[40:15] The federal Physician Self-Referral Law (42USC1395)
The Physician Self-Referral Law, commonly referred to as the Stark law, prohibits physicians [practitioners] from referring patients to receive "designated health services" payable by Medicare or Medicaid from entities with which the physician [practitioner] or an immediate family member has a financial relationship.
(Office of Inspector General DHHS)
[40:16] Without Medicare, Medicaid, and the permissibility of the existence of for-profit insurance companies, the medical profession would not exist in the lucrative position that it currently enjoys. In exchange, society requires that practitioners in their practice only focus on being a patient-center profession maximizing the patient’s best interests according to the patient’s reasonable goals, values, and priorities.
Conclude
[40:17] It is legally, professionally, and morally impermissible to combine medicine with product sales for capitalistic gain. Society has already given high social and economic rewards towards the profession of medicine, and to break that altruistic patient-centered social-contract for economic gain is unaccepted. Providing necessary but not readily available products for patients is accepted as long as the products comply with medical standards of care, and it is communicated to the patient that the products are being sold at cost with no added remuneration.
[40:18] In summary, the sale of products by medical practitioners is considered a conflict of interest and regulated legally, professionally, and ethically as it threatens the patient-practitioner relationship and public trust in the medical profession. Product sales risk the erosion of patient trust, which is essential for informed consent and the pursuit of the patient’s best interests. The sale of necessary but not readily available products is acceptable, while selling readily available items such as vitamins and cosmetics is not acceptable. Society has already given high social and economic rewards towards the profession of medicine, and practitioners must only focus on being a patient-center profession.
**
40. Review Questions
1. Product sales or endorsements by a practitioner are considered a conflict of interest and therefore regulated legally, professionally, and ethically.
2. The sale of products from the practitioner’s office for profit is not considered a form of self-referral.
3. The practitioner’s professional prime directive is patient-centered: maximize the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities using the principles of beneficence (do good) and nonmaleficence (do no harm).
4. If the practitioner is making products available that are necessary for providing the medical standards of care, not readily available, and without any financial gain, such as crutches, that is accepted.
5. The sale of readily available items such as vitamins and cosmetics for economic gain is not prohibited.
6. The Physician Self-Referral Law, commonly referred to as the Stark law, prohibits practitioners from referring patients to receive "designated health services" payable by Medicare or Medicaid from entities with which the practitioner or an immediate family member has a financial relationship.
**
Wrong 😕
[40:2] Product sales or endorsements by a practitioner are considered a conflict of interest and therefore regulated legally, professionally, and ethically. Practitioners engaging in product sales threaten the patient-practitioner relationship and how society perceives and interacts with the medical profession.
CORRECT! 🙂
[40:2] Product sales or endorsements by a practitioner are considered a conflict of interest and therefore regulated legally, professionally, and ethically. Practitioners engaging in product sales threaten the patient-practitioner relationship and how society perceives and interacts with the medical profession.
Wrong 😕
[40:5] American College of Physicians (ACP) Ethics Manual states:
The sale of products from the physician’s [practitioner’s] office might also be considered a form of self-referral and might negatively affect the trust necessary to sustain the patient-physician [practitioner] relationship.
CORRECT! 🙂
[40:5] American College of Physicians (ACP) Ethics Manual states:
The sale of products from the physician’s [practitioner’s] office might also be considered a form of self-referral and might negatively affect the trust necessary to sustain the patient-physician [practitioner] relationship.
CORRECT! 🙂
[40:7] The practitioner’s professional prime directive is the patient-centered maxim: maximize the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities using the principles of beneficence (do good) and nonmaleficence (do no harm). Although product sales do not necessarily violate the principles of beneficence (do good) or nonmaleficence (do no harm), it does violate the patient-centered focus, thereby violating the trusting relationship.
Wrong 😕
[40:7] The practitioner’s professional prime directive is the patient-centered maxim: maximize the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities using the principles of beneficence (do good) and nonmaleficence (do no harm). Although product sales do not necessarily violate the principles of beneficence (do good) or nonmaleficence (do no harm), it does violate the patient-centered focus, thereby violating the trusting relationship.
CORRECT! 🙂
[40:10] If the practitioner is making products available that are necessary for providing the medical standards of care but are not readily available, and without any financial gain, such as crutches, then doing so is legally, professionally, and morally accepted. Readily available items such as vitamins and cosmetics are not accepted.
Wrong 😕
[40:10] If the practitioner is making products available that are necessary for providing the medical standards of care but are not readily available, and without any financial gain, such as crutches, then doing so is legally, professionally, and morally accepted. Readily available items such as vitamins and cosmetics are not accepted.
CORRECT! 🙂
[40:10] If the practitioner is making products available that are necessary for providing the medical standards of care but are not readily available, and without any financial gain, such as crutches, then doing so is legally, professionally, and morally accepted. Selling to patients readily available items such as vitamins and cosmetics is not accepted.
Wrong 😕
[40:10] If the practitioner is making products available that are necessary for providing the medical standards of care but are not readily available, and without any financial gain, such as crutches, then doing so is legally, professionally, and morally accepted. Selling to patients readily available items such as vitamins and cosmetics is not accepted.
CORRECT! 🙂
[40:14] American College of Physicians (ACP) Ethics Manual states:
The sale of products from the physician’s [practitioner’s] office might also be considered a form of self-referral.
[40:15] The federal Physician Self-Referral Law (42USC1395)
The Physician Self-Referral Law, commonly referred to as the Stark law, prohibits physicians [practitioners] from referring patients to receive "designated health services" payable by Medicare or Medicaid from entities with which the physician [practitioner] or an immediate family member has a financial relationship. (Office of Inspector General DHHS)
Wrong 😕
[40:14] American College of Physicians (ACP) Ethics Manual states:
The sale of products from the physician’s [practitioner’s] office might also be considered a form of self-referral.
[40:15] The federal Physician Self-Referral Law (42USC1395)
The Physician Self-Referral Law, commonly referred to as the Stark law, prohibits physicians [practitioners] from referring patients to receive "designated health services" payable by Medicare or Medicaid from entities with which the physician [practitioner] or an immediate family member has a financial relationship. (Office of Inspector General DHHS)
40. Clinical Vignettes
1. Mr. Simpson is a 55-year-old retired engineer who visited his primary care practitioner, for his annual check-up. During the consultation, the practitioner recommended a new multivitamin supplement and offered to sell it to Mr. Simpson from the office. Mr. Simpson is unsure whether he needs the supplement but feels obligated to buy it to maintain a good relationship with his doctor. He has no known allergies, and his physical exam and lab results are normal. What ethical concern is raised by the practitioner offer to sell Mr. Simpson the multivitamin supplement?
2. Ms. Jackson, a 55-year-old accountant, visits her primary care practitioner complaining of knee pain. Physical examination and imaging reveal signs consistent with osteoarthritis. The practitioner recommends physical therapy and provides Ms. Jackson with a prescription for an over-the-counter pain reliever. The practitioner also offers to refer Ms. Jackson to a physical therapist. What should the practitioner do?
3. Ms. Katherine Jones is a 62-year-old retired teacher who has been visiting her primary care practitioner, Dr. Patel, for joint pain in her knees. During her last visit, Dr. Patel suggested that she should try a dietary supplement that he sells at his office. Ms. Jones is hesitant but trusts Dr. Patel and decides to purchase the supplement. However, after taking the supplement for a few days, Ms. Jones starts experiencing stomach pain and dizziness. She calls Dr. Patel's office, and a nurse informs her that these symptoms are normal and that she should continue taking the supplement. Ms. Jones is concerned about her health and seeks a second opinion. What is the ethical question raised in this clinical vignette?
4. Mrs. Johnson, a 70-year-old retired schoolteacher, visits her primary care practitioner with a sprained ankle. Physical examination reveals significant swelling and tenderness. The practitioner recommends that Mrs. Johnson use crutches and rest her ankle for a few days. The practitioner inquires as to whether or not Mrs. Johnson has a pair of crutches at home, as she does not. Which of the following would be the most ethical action for the practitioner?
5. Ms. Lee, a 65-year-old retired teacher, visits her primary care practitioner complaining of hip pain. Physical examination reveals signs consistent with osteoarthritis. The practitioner recommends physical therapy, weight loss, and the use of a cane to alleviate Ms. Lee's symptoms. The practitioner also offers to provide Ms. Lee with a cane, which the practitioner claims is of high quality and will better suit Ms. Lee's needs than a store-bought cane. What should the practitioner do?
CORRECT! 🙂
Explanation: The practitioner's offer to sell the multivitamin supplement to Mr. Simpson raises concerns about patient autonomy. Autonomy refers to the patient's right to make decisions about their own health care. By offering to sell the supplement, the practitioner creates a conflict of interest that may undermine Mr. Simpson's ability to make an informed decision about his health care needs. The American College of Physicians (ACP) Ethics Manual states that the sale of products from a practitioner's office may negatively affect the trust necessary to sustain the patient-practitioner relationship and erode patient autonomy [40:5]. The patient's trust in the practitioner's competence and information provided is crucial for informed consent [40:4]. The practitioner's offer to sell the supplement may make Mr. Simpson feel obligated to purchase it to maintain a good relationship with his doctor, which can undermine his autonomy. Although Beneficence and Nonmaleficence are important ethical principles in medicine, they are not the main issue in this scenario. Beneficence refers to the professional duty to do good for the patient, and nonmaleficence refers to the professional duty to do no harm. Although product sales do not necessarily violate the principles of beneficence or nonmaleficence, they do violate the patient-centered focus, thereby violating the trusting relationship [40:7]. Justice refers to the fair and equitable distribution of resources. While product sales can raise issues of justice, the main ethical concern in this case is patient autonomy.
Wrong 😕
Explanation: The practitioner's offer to sell the multivitamin supplement to Mr. Simpson raises concerns about patient autonomy. Autonomy refers to the patient's right to make decisions about their own health care. By offering to sell the supplement, the practitioner creates a conflict of interest that may undermine Mr. Simpson's ability to make an informed decision about his health care needs. The American College of Physicians (ACP) Ethics Manual states that the sale of products from a practitioner's office may negatively affect the trust necessary to sustain the patient-practitioner relationship and erode patient autonomy [40:5]. The patient's trust in the practitioner's competence and information provided is crucial for informed consent [40:4]. The practitioner's offer to sell the supplement may make Mr. Simpson feel obligated to purchase it to maintain a good relationship with his doctor, which can undermine his autonomy. Although Beneficence and Nonmaleficence are important ethical principles in medicine, they are not the main issue in this scenario. Beneficence refers to the professional duty to do good for the patient, and nonmaleficence refers to the professional duty to do no harm. Although product sales do not necessarily violate the principles of beneficence or nonmaleficence, they do violate the patient-centered focus, thereby violating the trusting relationship [40:7]. Justice refers to the fair and equitable distribution of resources. While product sales can raise issues of justice, the main ethical concern in this case is patient autonomy.
CORRECT! 🙂
Explanation: The Physician Self-Referral Law, commonly referred to as the Stark Law, prohibits practitioners from referring patients to receive designated health services payable by Medicare or Medicaid from entities with which the practitioner or an immediate family member has a financial relationship [40:15]. Referring Ms. Jackson to a physical therapist with whom the practitioner has a financial relationship is a violation of the Stark Law and could damage the trust between the practitioner and the patient [40:9]. Referring Ms. Jackson to a physical therapist without a financial relationship with the practitioner is the appropriate course of action, as it avoids the appearance of a conflict of interest and ensures that the patient's best interests are being served [40:1]. Advising Ms. Jackson to search for a physical therapist on her own may not be practical or helpful, and providing physical therapy in the practitioner's office may not be feasible or appropriate for the patient's needs.
Wrong 😕
Explanation: The Physician Self-Referral Law, commonly referred to as the Stark Law, prohibits practitioners from referring patients to receive designated health services payable by Medicare or Medicaid from entities with which the practitioner or an immediate family member has a financial relationship [40:15]. Referring Ms. Jackson to a physical therapist with whom the practitioner has a financial relationship is a violation of the Stark Law and could damage the trust between the practitioner and the patient [40:9]. Referring Ms. Jackson to a physical therapist without a financial relationship with the practitioner is the appropriate course of action, as it avoids the appearance of a conflict of interest and ensures that the patient's best interests are being served [40:1]. Advising Ms. Jackson to search for a physical therapist on her own may not be practical or helpful, and providing physical therapy in the practitioner's office may not be feasible or appropriate for the patient's needs.
Wrong 😕
Explanation: The ethical question raised in this clinical vignette is whether it is ethically acceptable for a medical practitioner to sell products to patients [40:2]. The medical profession's patient-centered maxim of "patient's best interests" conflicts with the capitalistic doctrine of "Caveat Emptor" (let the buyer beware) [40:1]. The sale of products by medical practitioners is considered a conflict of interest and is regulated legally, professionally, and ethically as it threatens the patient-practitioner relationship and public trust in the medical profession [40:2]. Dr. Patel's suggestion and sale of the supplement to Ms. Jones pose a conflict of interest and a violation of the patient-centered focus, thereby violating the trusting relationship [40:4]. The American College of Physicians (ACP) Ethics Manual and the American Medical Association (AMA) Code of Medical Ethics both highlight concerns about financial conflicts of interest, erosion of patient trust, and the ethical implications of product sales [40:5, 40:9].
CORRECT! 🙂
Explanation: The ethical question raised in this clinical vignette is whether it is ethically acceptable for a medical practitioner to sell products to patients [40:2]. The medical profession's patient-centered maxim of "patient's best interests" conflicts with the capitalistic doctrine of "Caveat Emptor" (let the buyer beware) [40:1]. The sale of products by medical practitioners is considered a conflict of interest and is regulated legally, professionally, and ethically as it threatens the patient-practitioner relationship and public trust in the medical profession [40:2]. Dr. Patel's suggestion and sale of the supplement to Ms. Jones pose a conflict of interest and a violation of the patient-centered focus, thereby violating the trusting relationship [40:4]. The American College of Physicians (ACP) Ethics Manual and the American Medical Association (AMA) Code of Medical Ethics both highlight concerns about financial conflicts of interest, erosion of patient trust, and the ethical implications of product sales [40:5, 40:9].
CORRECT! 🙂
Explanation: According to the American College of Physicians (ACP) Ethics Manual, if the practitioner is making products available that are necessary for providing the medical standards of care, not readily available, and without any financial gain, such as crutches, that is accepted [40:10]. In this case, the practitioner is lending Mrs. Johnson a pair of crutches free of charge, which is a permissible and ethical action. This is consistent with the principle of beneficence, as it promotes the patient's best interests, and the principle of nonmaleficence, as it does not harm the patient. The other options involve a financial gain for the practitioner, which could be perceived as a conflict of interest and could erode patient trust in the practitioner [40:2] [40:5] [40:9]. Refusing to lend would not promote Mrs. Johnson's best interests and could harm her by delaying her recovery [40:6].
Wrong 😕
Explanation: According to the American College of Physicians (ACP) Ethics Manual, if the practitioner is making products available that are necessary for providing the medical standards of care, not readily available, and without any financial gain, such as crutches, that is accepted [40:10]. In this case, the practitioner is lending Mrs. Johnson a pair of crutches free of charge, which is a permissible and ethical action. This is consistent with the principle of beneficence, as it promotes the patient's best interests, and the principle of nonmaleficence, as it does not harm the patient. The other options involve a financial gain for the practitioner, which could be perceived as a conflict of interest and could erode patient trust in the practitioner [40:2] [40:5] [40:9]. Refusing to lend would not promote Mrs. Johnson's best interests and could harm her by delaying her recovery [40:6].
CORRECT! 🙂
Explanation: As stated in [40:10], it is acceptable for a practitioner to make products available that are necessary for providing the medical standards of care, not readily available, and without any financial gain, such as crutches. In this case, the practitioner can provide Ms. Lee with a cane if it is necessary for her care and if it is not readily available. However, the practitioner cannot sell the cane for financial gain, as this would be considered a conflict of interest [40:2]. The practitioner should explain to Ms. Lee that the cane is being provided for her care and is not being sold for financial gain. Referring Ms. Lee to a medical supply store may not be necessary if the cane is not readily available and it is necessary for her care. Providing Ms. Lee with a cane at no cost may be a kind gesture, but it is not required and could potentially raise concerns about undue influence or favoritism.
Wrong 😕
Explanation: As stated in [40:10], it is acceptable for a practitioner to make products available that are necessary for providing the medical standards of care, not readily available, and without any financial gain, such as crutches. In this case, the practitioner can provide Ms. Lee with a cane if it is necessary for her care and if it is not readily available. However, the practitioner cannot sell the cane for financial gain, as this would be considered a conflict of interest [40:2]. The practitioner should explain to Ms. Lee that the cane is being provided for her care and is not being sold for financial gain. Referring Ms. Lee to a medical supply store may not be necessary if the cane is not readily available and it is necessary for her care. Providing Ms. Lee with a cane at no cost may be a kind gesture, but it is not required and could potentially raise concerns about undue influence or favoritism.
**
40. Reflection Vignettes
1. Dr. Sarah Lee is a 40-year-old medical practitioner who recently started selling vitamins and cosmetics in her local practice. She noticed that most of her patients are compelled to buy her products because they trust that she will only sell "good" products to them. For the patients, purchasing the products is also a sign of support for Dr. Lee's practice, and if they buy the products in front of her, they believe they will get some extra special care. Dr. Lee needs to understand that selling products to her patients is a potential conflict of interest and can jeopardize her patients' trust in her. Patients may feel pressured to buy products they do not need, and it may negatively impact their perception of Dr. Lee's medical expertise. As a medical practitioner, her priority should be to provide medical care and treatment to her patients, not to sell products for profit. Dr. Lee should focus on educating her patients on the importance of a healthy lifestyle, including proper nutrition and exercise, and provide evidence-based recommendations for any necessary supplements. Dr. Lee should not sell any products that are readily available and any necessary or specialized goods should be backed by scientific evidence. If for patient care it is necessary to sell goods, then their must be full disclose of any financial interest she has in selling the products to her patients to avoid any perception of impropriety.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
**
2. Dr. Alex Nguyen, a 40-year-old practitioner, has been operating in a rural community for the past 10 years. The community does not have access to an MRI machine, so Dr. Nguyen decides to invest in an MRI machine to better serve his patients and generate some additional income for his practice. However, Dr. Nguyen must take precautions and communicate effectively with his patients before referring them to receive an MRI. Federal and state governments have laws in place to protect patients from practitioners who exploit their vulnerability and financial gain. For example, Illinois Law 225ILCS22 prohibits the promotion of the sale of drugs, devices, or goods that exploit the patient for the financial gain of the practitioner. Additionally, the American College of Physicians (ACP) Ethics Manual warns against the sale of products from the practitioner's office, as it may be considered a form of self-referral. The federal Physician Self-Referral Law, commonly known as the Stark Law, also prohibits practitioners from referring patients to receive designated health services payable by Medicare or Medicaid from entities with which the practitioner or an immediate family member has a financial relationship. In essence, the medical profession exists because of the trust society has in practitioners to prioritize their patients' best interests. Therefore, practitioners must focus on being a patient-centered profession that maximizes the patient's best interests according to their reasonable goals, values, and priorities.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
***
