Eroding the ethics of our profession is no way to solve financial problems

I ran across an interesting post and found in addition an easy to read and informative blog.

Dr Freedhoff has been keeping an eye on the AAFP-Coke relationship and reviewing the results.

I post today to express my increasing dismay with the choices made by my specialty society. 

In these troubled times for primary care we must stand together for our profession and our selection of primary care as specialty.  Ours is a noble profession granted rights and vested with responsibilities beyond most other human endeavor.  We debase ourselves when we follow a path that appears to put our wallet before our ethics.

I am reasonably certain that the AAFP would never have considered the relationship had they not been financially pressed but this was an unfortunate solution.

The issue of professional ethics and finance in health care is immense and I've touched on only one infinitesimally small part.  Each and every one of us is faced with ethical quandaries on a daily basis:

• Do I spend the extra time trying to clear the stupid administrative hurdles and get the prior authorization for the right drug or go with a so-so alternative?
• This test might help or might not - I seem to recall that there was a study saying it caused more risk than benefit - but I don't have the time to look it up.

The daily toll of these choices is exhausting.  Now I feel like I have one more brick on my back:

• Do I continue my AAFP membership or not?

Comments

[Sofia Fernandez]

I am so glad we can have an educated discussion about the pros and cons and term definitions without shouting at one another. How refreshing!

[Yoni Freedhoff]

Thanks for the shout-out.

Regarding your AAFP membership - if you're on the fence perhaps my post tomorrow will push you off.

Regards,
Yoni

[Nancy Walton]

Hi there,

I read your post with interest. I'm quoting you here in regard to the kind of "ethical choices" you cite, that occur on a daily basis for practitioners:

"Do I spend the extra time trying to clear the stupid administrative hurdles and get the prior authorization for the right drug or go with a so-so alternative?
This test might help or might not - I seem to recall that there was a study saying it caused more risk than benefit - but I don't have the time to look it up."

These may well be choices that have ethical principles involved in how you work them out (acting beneficently, avoiding harm, providing equitable access to standard of care and promoting autonomous choices for patients) but they are clearly professional obligations you have - to suffer administrative hurdles so that patients can be prescribed the correct drug or to have to look up a test or drug to determine the effectiveness or risk for a specific patient.

Too often, the term "ethics" is overused and misused in situations where people are simply faced with a choice. "To do the right thing" does not imply that the choice you had necessarily involved "ethics". If in fact, looking drugs or tests up before administering or ordering them was in fact a purely "ethical" choice, we would have no need for standards of care, best practices or even clear, explicit professional obligations.

It's important that we not put everything under the ever-widening umbrella of "ethics", thus implying that there is some principled "choice" one makes when providing standard of care to patients, instead of merely the clear obligation one has to act professionally and responsibly.

Thanks for the blog and the posting. Interesting reading.

Nancy Walton, PhD
www.researchethics.ca/blog