We live in an entitlement society. I am not referring to Medicare and Social Security but to a prevailing sense of personal privilege, to people who believe they are owed everything just because they are who they are. This phenomenon cuts across income classes and age groups, but the entitlement bug seems especially acute among professionals. Many demand the highest conceivable incomes, the most lavish executive perks and outside income, the biggest houses, the fanciest cars and whatever else they can get their hands on, regardless of the organizational or social cost.
The results of this greed are the rampant conflicts of interest we see today at the highest executive levels, the outrageous paydays, the cutting of legal corners and a plague of white-collar crime not seen since the days of the robber barons. That's why it came as no surprise that a survey by the American College of Physician Executives found that in the opinion of a majority of 1,500 physician leaders, financial conflicts of interest and a range of other unethical behavior are endangering the U.S. healthcare system (March 7, p. 6). Let's be clear: The survey could have been about the beer industry, the clothing industry, the law, politics, sports or whatever. A growing number of people in every field of endeavor are willing to bend any law, rule, guideline, oath, commandment or covenant to get ahead of the next guy-as long as they don't get caught. It's getting so that the many people who aren't morally, ethically and legally challenged feel like chumps.
In response, healthcare organizations have been toughening up voluntary professional codes of conduct. These are good-faith, thoughtful statements of intent, and the organizations that promulgate them have an obligation to do what they can in an era when the national id seems to have taken over. But the ACPE survey found that most organizations don't enforce these codes, so the results shouldn't surprise anyone.
Janet Woodcock, acting deputy commissioner of operations for the Food and Drug Administration, told a Senate committee recently that drug companies are still enticing doctors to overprescribe their drugs in exchange for free cruises and stays at exotic resorts. The drugmaker payola was supposed to have ended with the 2002 voluntary code of conduct adopted by the Pharmaceutical Research and Manufacturers of America and warnings to doctors from the American Medical Association, the ACPE and provider organizations not to accept any more gifts. Yet 80% of respondents to the ACPE survey believe this is still a major problem.
The AMA, despite its past rhetoric, hasn't gotten its own message. Its president, John Nelson, told us: "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." Rare? What world does Nelson inhabit? Does he really think that it's a rare situation when physicians overtreat people to make more money?
A visit to the AMA's Web site, ama-assn.org, shows that tort reform and Medicare reimbursement are its top two concerns. The latter issue may contain one solution to the ethical challenges facing physicians and healthcare in general. A physician pay-for-performance pilot program has been launched by the CMS. If someday pay for performance is the only form of reimbursement available, the incentive to do anything that doesn't result in quality outcomes would be reduced.
Until that far-off day, about the only thing we can do is to keep pointing out every instance we can of providers failing to adhere to the standards of their profession and saluting those who know that taking care of patients is their only job.
What do you think?
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