According to Wikipedia, conflict of interest (COI) occurs when an individual or organization is involved in multiple interests, one of which could possibly corrupt the motivation for an act. Areas of conflict discussed are: conflicts of economic incentives, conflicts with patient and physician autonomy, and conflicts of patient/physician relationships. Although the scope of this discussion is on managed care organizations (MCO), it is postulated that these infractions are universal.
Possibly, the most serious conflict would be economic incentives, which may occur when:
• Bonuses are directly related to the number of tests or referrals a physician makes
• The withhold of percentages of the provider’s compensation for large expenditures on patient care or use other risk-sharing arrangements.
• The linking of physician’s salary or incentive payments to spending or service utilization
When ones’ own personal survival is connected to these policies it is easy to understand the ethical and moral issues that may arise for physicians. Student’s loans, family obligations, and professional requirements demand that physician’s comply with MCOs guidelines in fear of being barred from participation. This is often in direct conflict with AMA Code of Ethics.
Conflicts with patient and physician autonomy directly affect the patient’s right to be self-governed. Often this is due to guidelines that limit the physician’s ability to gain needed clinical information by prohibiting additional testing or consultation adversely impacting physician and patient autonomy in decision-making.
The final area of concern is conflicts, which occur in the patient/physician relationship. Communication is one of the key factors of effective treatment. However, physicians often limit the information they share with patients. Poor communication is probably a far more pervasive and significant component in the loss of trust in physician–patient relationships than external factors, such as a loss or restriction on the freedom of choice of provider.
Other areas in which conflict may occur is in the area of research or physicians that have an ownership interest in a diagnostic treatment center may make some decisions based on profits, instead of patient’s needs or preferences.
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