Sunday, May 2, 2010

The Ethicist - A Doctor and His Imaging -

A specialist recommended that my wife get a CT scan and suggested that she use a lab in which, we later discovered, he has an interest. She wasn't required to use that lab, and there was no reason to question its quality or his calling for a scan. I'm O.K. with this lab — I say you either trust the specialist or you don't — but my wife is not so sure. What do you say? PETER THORNE, GLEN HEAD, N.Y.

I say it's more complicated than trust or don't trust. And so does Katie Watson, an assistant professor in the Medical Humanities and Bioethics Program at the Feinberg School of Medicine at Northwestern University: "I trust my physicians not to be criminals who intentionally order unnecessary tests to feed their yacht habits. I also trust them to be human beings, which means they're vulnerable to subconscious influences and incentives just like the rest of us."

That your wife's physician is trustworthy does not immunize him to conflicts of interest that can skew referrals. That's why a physician should not send patients to facilities in which he has a financial interest. It is neither prudent health policy nor good medical ethics to put a doctor or a patient in such a position.

Worse still, apparently your wife's physician was cagey about owning a piece of the action. You "later discovered" it. Here, too, Watson shares my discomfort, e-mailing me, "At minimum I believe physicians are ethically required to disclose their ownership interest and to direct patients to alternate service providers as well." The doctrine of informed consent compels physicians to give patients all pertinent information about their care. Because some patients might regard the ownership question as significant — your wife certainly does — her physician should have disclosed it.

Incidentally, the physician most likely broke no laws in keeping silent about his empire of diagnostic facilities and whether he owns a piece of that casino in Vegas where he suggested your wife go to recuperate. Watson again: "The laws regulating physician ownership of diagnostic and therapeutic services are complex. Much ownership is prohibited, but federal law has exceptions allowing ownership of some services (including imaging)." State laws vary, she adds, and some do require physicians to disclose ownership of certain facilities. But even where the law allows physicians to own imaging facilities, ethics does not.