Vested Self-interest: A Conflict of Interest in Medicine

February 9, 2011
Jeffrey Kaplan, MD

The doctor-patient relation is not symmetric -- it is a relation of trust.

Is a portion of doctors so self-interested that they are more interested in money than patient welfare? If so, isn't this a violation of the Hippocratic Oath?

A doctor tells a patient they need surgery but the patient's condition has improved since his or her recommendation. The patient is confused; they have another visit. The doctor suggests that the condition may come back. It’s a dire warning either in reality or more likely as perceived. Is this an example of the doctor's self-interest calling? What if the critical test (the one that confirmed the diagnosis) turns normal?

Examples: A hearing test in a patient with fluid in the middle-ear spaces shows improvement prior to placing tympanostomy tubes. Or CPAP is ordered for a patient who has lost weight and isn't snoring as much.

An MD/PhD/JD friend offers the following insightful comments and questions:

Do these examples represent a need for safeguards? In other words, do they represent a problem for those who insist on keeping lawmakers out of the doctor-patient relationship?

That doctor-patient relation is not symmetric -- it is a relation of trust. But, who can protect the patient if the doctor is not trustworthy and the whole transaction is kept secret?

Yes, doctors get their hackles up when their honor is impugned, but patient welfare is the primary imperative, not the doctors' egos.

Patients who insist on absolute privacy of their medical records, based on their irrational faith in the honor of their physicians, simply aid and abet the bad actors.