Conflict of duty
Skip to main content
Sister Publication Links
  • Modern Healthcare Metrics
MDHC_Logotype_white
Subscribe
  • Subscribe
  • Register
  • Login
  • News
    • This Week's News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • People
    • Regional News
    • Digital Edition
    • Senate, House negotiators announce bipartisan surprise billing deal
      Merrill Goozner
      Another half-measure for preventing HIV/AIDS transmission
      Dr. Richard Snyder
      Outdated privacy laws hinder coordinated care, especially in the fight against addiction
      Nurses recycle surgical wraps for the homeless
      Nurses sew surgical wraps into sleeping bags for the homeless
    • November was healthcare's second strongest hiring month of 2019
      Primary-care provider ChenMed to enter five new markets
      Lacking specialist access drives health disparities
      Genetic Counseling
      Addressing barriers to expanding genetic counseling
    • Joan Budden
      Q&A: Priority Health CEO eager to share best practices with Total Health Care
      Silver-loading, CSR elimination lowered premiums for some rural enrollees
      Centene to sell Illinois plan to CVS Health
      Blue Cross of Idaho unveils souped-up short-term health plans
    • Capitol Building with pills
      Week Ahead: House to vote on drug bill; SCOTUS hears risk-corridor case
      MedPAC thinks hospice payments are too high
      MedPAC says ambulatory surgical centers don't need a pay raise
      States focus on healthcare costs to address coverage problems
    • Analysts to CommonSpirit Health: Show us the savings
      Smallest hospitals saw biggest earnings gains last month
      Sutter Health postpones financial filing
      doctor helping patient stock image Sandoz
      Sponsored Content Provided By Sandoz
      As hospital executives look to reduce costs, biosimilars offer a compelling option
    • astronaut
      Astronauts developed bloodstream issues in space
      Sponsored Content Provided By ABM Healthcare
      Protecting and Maintaining Medical Devices
      human hand robotic hand stock image
      Sponsored Content Provided By Deloitte
      The Health System of the Future: How Digital Health Technology is Transforming Care
      EHR
      EHR vendors most in-use throughout Medicare incentive program
    • MRIs of dense breasts find more cancer but also false alarms
      Flu season takes off quickly in Deep South states
      Uber driver says South Carolina hospital dumped patient on him
      1 in 3 adults age 45 and older reported being lonely in a 2018 AARP survey
      Data Points: Loneliness and its impact on health
    • Jim Allison playing the harmonica
      Documentary tells tale of Nobel winning researcher
      Seema Verma
      Seema Verma's bold initiatives land her in No. 1 'Most Influential' spot
      New CEO takes the helm at Lurie Children's Hospital of Chicago
      Mayo Clinic taps Dr. John Halamka to lead its Google partnership
    • Midwest
    • Northeast
    • South
    • West
  • Special Features
    • Best Practices
    • InDepth Special Reports
    • Innovations
    • Chest x-ray from a patient with a vaping-related lung injury
      Vaping-related cases lead to care guidelines from Intermountain
      Arkansas Children’s was a founding partner in Solutions for Patient Safety.
      Children's hospitals collaborate rather than compete on patient safety
      Peer recovery specialists at St. Barnabas Medical Center work with nurse Brenna Zarra.
      Peer recovery helping patients with addiction seek treatment
      UNC Health Care trains staff to treat dementia patients
    • Linda Kenney
      Patient advocate recalls two medical errors that nearly killed her
      Betsy Lehman
      Recent safety scandals suggest healthcare leaders haven't learned lessons
      Doctors and nurse with patient
      20 years after 'To Err is Human,' hospital care quality measures are still of little use
      Dr. Christine Cassel
      To err is human. That’s still true 20 years later, but some solutions to the problem aren’t helping
    • Advanced ICU Care
      Telemedicine helps rural hospitals meet intensivist shortage
      Randy Oostra, CEO of ProMedica
      HCR ManorCare deal laid foundation for ProMedica’s growth
      Paging Dr. Robot: Artificial intelligence moves into care
      A child being screened for vision problems using a smartphone.
      App screens kids for eye problems before they can talk
  • Transformation
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • ProMedica doubles down on social needs data analysis
      Amazon taps first pharmacy for Alexa Rx management
      Trump administration unveils new price transparency rules
      A child being screened for vision problems using a smartphone.
      App screens kids for eye problems before they can talk
    • VA dives into artificial intelligence R&D
      Home health to pare down therapy services, up telehealth offerings
      Amazon launches medical transcription service
      Hospitals' uncompensated care continues to rise
    • Chest x-ray from a patient with a vaping-related lung injury
      Vaping-related cases lead to care guidelines from Intermountain
      Advanced ICU Care
      Telemedicine helps rural hospitals meet intensivist shortage
      Peer recovery specialists at St. Barnabas Medical Center work with nurse Brenna Zarra.
      Peer recovery helping patients with addiction seek treatment
      UNC Health Care trains staff to treat dementia patients
    • Value-based pay still struggles to improve costs, quality
      Hospitals sue HHS over negotiated price disclosure rule
      Bundled payments get a boost in two states with employee programs
      CMS wants primary-care docs to take on financial risk
  • Data/Lists
    • Rankings/Lists
    • Data Points
    • Modern Healthcare Metrics
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
    • Randy Oostra, CEO of ProMedica
      HCR ManorCare deal laid foundation for ProMedica’s growth
      Steve Strongwater
      How Atrius Health stayed independent by not shying away from risk
      Why moving the VA to a new EHR was a pivotal decision
      Why AdventHealth's rebrand was more than a name change
    • Terry Shaw
      A diverse and inclusive culture should empower others
      Paving the path to diversity and inclusion
      The next step in healthcare evolution
      Breaking Bias: A road map to boost women and minorities into healthcare leadership
    • Dr. Richard Snyder
      Outdated privacy laws hinder coordinated care, especially in the fight against addiction
      David Dill and Keith Myers
      Healthcare partnerships are a proven path to better care, healthier communities
      Health systems need to devote more resources to caring for the caregivers
      Chip Kahn and Alan Morgan
      Rural healthcare needs innovation, policy changes to survive
    • Letters: Let’s keep humanity in discussions about patient safety
      Hospital with money
      Letters: Let providers set their prices,
 and then publish them all
      Letters: Ambulatory surgery centers aren't getting a break on regulation
      Letters: Rising Medicaid spending isn't a windfall for providers
    • Sponsored Content Provided By Optum
      How blockchain could ease frustration with the payment process
      Sponsored Content Provided By Optum
      Three steps to better data-sharing for payer and provider CIOs
      Sponsored Content Provided By Optum
      Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together
      Sponsored Content Provided By Optum
      Why CIOs went from back-office operators to mission-critical innovators
  • Awards
    • Nominate
    • Award Programs
    • Previous Award Programs
    • Other Award Programs
    • Nominations Open - Top 25 Minority Leaders
      Nominations Open - Health Care Hall of Fame
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Top 25 Minority Leaders
    • Top 25 Women Leaders
    • Excellence in Nursing Awards
    • Design Awards
    • Top 25 COOs in Healthcare
    • 100 Top Hospitals
    • ACHE Awards
  • Events
    • Conferences
    • Galas
    • Webinars
    • Kronos webinar logo lockup
      Sponsored Content Provided By Kronos
      Webinar: The Future of Work in Healthcare
    • Leadership Symposium
    • Healthcare Transformation Summit
    • Critical Connections: Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Workplace of the Future Conference
    • Strategic Marketing Conference
    • Health Care Hall of Fame Gala
    • Top 25 Women Leaders Gala
    • Best Places to Work Awards Gala
    • Top 25 Minority Leaders Gala (2020)
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Physicians
December 01, 2000 12:00 AM

Conflict of duty

Medical professionalism requires more than self-oversight

Other News Source
  • Tweet
  • Share
  • Share
  • Email
  • More
    Print

    One more challenge for physicians in the 21st century is addressing the quandary emerging over the concept of medical professionalism within an evolving healthcare system. At the heart of this debate is the conflict between the traditional Hippocratic ideal of clinical loyalty to individual patients and the broader managed care focus on the health of entire populations. Given this disparity, how do physicians rationalize the concept of medical professionalism with an industrial model of medicine and make it relevant for contemporary healthcare delivery?

    The terms of the contract between physicians and their patients are defined by medical ethics, while the enforcement of the contract is assured through professional accountability.

    The medical ethics component of professionalism is far too complex a topic to address here. However, the medical professionals bound by this social contract must be monitored for observing whatever behavior is deemed ethical at the time.

    Such accountability lies at the very core of any profession, and the responsibility for that accountability must be clearly and effectively established.

    Physicians have clearly expressed their dissatisfaction with any external responsibility for this accountability imposed by insurance companies and managed care organizations. Indeed, a study published in the March issue of theJournal of the American Medical Association found that 81% of surveyed physicians believe that changes in the healthcare system over the past 10 years have diminished their accountability to their patients.

    On the other hand, physician preference for such accountability is merely a return to the self-regulation that has been woefully ineffective in the past.

    State licensing boards, hospital medical staffs and peer review organizations have been reluctant to discipline anything less than the most egregious physician conduct. Yet on an individual basis physicians may ignore advances in clinical practice; abuse drugs and alcohol; overstep professional boundaries in physician-patient conduct; succumb to the financial temptations of fee-for-service reimbursement; or defraud third party payers in their billing and coding practices.

    Therein lies the challenge for medical professionalism in the future, since neither self-regulation nor external accountability has resulted in the desired professional behavior. However, by virtue of being a profession, self-regulation is presumed, since everyone outside that profession lacks the knowledge or experience to do it appropriately. While that was certainly well demonstrated by the failed attempts of managed care to regulate physician behavior, what options for self-regulation remain?

    The problems with self-regulation result from placing responsibility for behavioral accountability with individual physicians. Obviously, expecting each physician to be responsible for his or her own behavior is inadequate because not all physicians accept such responsibility. Even when placing the responsibility with groups of physicians, like medical staff committees or peer review organizations, many physician members function from an individual perspective, while each maintains personal liability for their own decisions.

    However, three options exist for collectively accepting responsibility for medical professionalism, so that the perspective is broadened and the liability mitigated. They are professional associations, trade associations or physician unions, and physician organizations.

    Professional associations are typically specialty-focused and may offer the accountability needed. For example, the American Board of Family Practice influenced physician clinical behavior when it required re-examination every seven years in order to maintain board certification. Unfortunately, the natural constituency of these associations is their specialty members, not all patients or physicians, so their focus may be too limited for comprehensive oversight of medical professionalism.

    In a similar manner, the agenda for trade associations and physician unions tends to be the protection of its physician members from the vicissitudes of the marketplace, rather than holding the behavior of its members accountable to that marketplace. Furthermore, while lip service may be provided to patient advocacy, the constituents of these organizations are clearly physicians and not patients.

    Thus their oversight of medical professionalism is precluded by a substantial conflict of interest.

    Physician organizations include academic faculty practice plans, IPAs and medical groups. Medical staffs, peer review committees and quality oversight committees do not qualify as true physician organizations, for while comprised of physicians, their agenda and constituency often serve other organizations, like hospitals or state licensing boards.

    In truly effective physician organizations, like the Mayo Clinic or the Cleveland Clinic, individual physicians assume collective responsibility for both clinical and business decisions of their organization. This allows them the breadth and objectivity required for overseeing medical professionalism, while their organizational status insulates them from any personal liability for their decisions. However, their ability to function optimally will ultimately be determined by the organizational integrity of their structure.

    The physician organization model for accountability avoids the interference of nonphysicians in medical care delivery, while allowing collective responsibility to the organization to overcome the inherent weaknesses of self-regulation. Such collective self-regulation, in which the whole is greater than the sum of its parts, would appear to be an effective model for the accountability in the future. While the debate over medical professionalism continues, it remains to be seen whether physicians can make the sacrifices of personal autonomy necessary to preserve their professional autonomy through an organizational model of their choosing.


    Thomas Mayer, M.D., is executive director of managed care education for the Institute for Healthcare Advancement, a Whitter, Calif.-based not-for-profit organization that seeks to advance healthcare delivery through education and demonstration of innovative healthcare practices.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Sponsored Content
    Get Free Newsletters

    Sign up for free enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today

    The weekly magazine, websites, research and databases provide a powerful and all-encompassing industry presence. We help you make informed business decisions and lead your organizations to success.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS
    • Instagram

    Stay Connected

    Join the conversation with Modern Healthcare through our social media pages

    MDHC_Logotype_white
    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    Modern Healthcare
    Copyright © 1996-2019. Crain Communications, Inc. All Rights Reserved.
    • News
      • This Week's News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition
    • Special Features
      • Best Practices
      • InDepth Special Reports
      • Innovations
    • Transformation
      • Patients
      • Operations
      • Care Delivery
      • Payment
    • Data/Lists
      • Rankings/Lists
      • Data Points
      • Modern Healthcare Metrics
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Nominate
      • Award Programs
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Top 25 Minority Leaders
        • Top 25 Women Leaders
      • Previous Award Programs
        • Excellence in Nursing Awards
        • Design Awards
        • Top 25 COOs in Healthcare
      • Other Award Programs
        • 100 Top Hospitals
        • ACHE Awards
    • Events
      • Conferences
        • Leadership Symposium
        • Healthcare Transformation Summit
        • Critical Connections: Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
        • Workplace of the Future Conference
        • Strategic Marketing Conference
      • Galas
        • Health Care Hall of Fame Gala
        • Top 25 Women Leaders Gala
        • Best Places to Work Awards Gala
        • Top 25 Minority Leaders Gala (2020)
      • Webinars
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing