“A conflict of interest arises where a reasonable person could think that a physician’s duty to act in the patient’s best interests may be affected or influenced by other competing interests …”
— Conflict of Interest, College of Physicians and Surgeons of B.C.
The Professional Standards and Guidelines of the College of Physicians and Surgeons of B.C. present clear definitions of conflict of interest, describe how practitioners can avoid it and place “real” or “perceived” conflicts on an almost equal footing.
Noting patients are “vulnerable in relation to physicians,” the guidelines say they “rely on physicians and must be confident their needs are considered foremost.” In other words, a patient’s best interests must come before profit or any other beneficial considerations.
More directly, the linked Sale of Products in the Office guideline addresses “for profit” sales — activities most likely to lead to conflict with professional practice.
Of interest is that “sale of products that need to be administered in a medical office setting (for example, intraocular lenses. . . .)” would be “considered appropriate by the College.”
Does that imply an ophthalmologist should not “sell” lenses if they will be implanted in a hospital setting — where cataract procedures are routinely performed?
Be that as it may, where licentiates of the college are concerned, the code reassures us that our medical care is in ethical and professional hands.
So how do the guidelines play out in the real world at a time when British Columbia is moving inexorably toward increased privatization of healthcare?
More importantly, how do they play out with respect to “for-profit” commercial activities of other practitioners who are an integral part of what most people regard as an all-encompassing healthcare system?
Because first on the CPSBC list of “common situations that might give rise to a real or perceived conflict. . . .” is the promotion or selling of “products to patients for profit. . . .” which makes this discussion particularly relevant to the work of podiatrists, optometrists, audiologists and other such practitioners — most of which are governed by the regulations of their own colleges or associations.
Podiatrists evaluate their clients’ gait and foot conditions and then sell orthotics or other solutions to problems they have diagnosed as being in need of correction.
Optometrists work out of offices in eyewear stores. They test their clients’ vision and, if correction is required, write up a prescription to be taken to the front counter so that another staffer can help with frame-selection and measurement of for-profit eyeglasses to be prepared by an outside laboratory.
Most secretive — and perhaps lucrative — of the three cited examples involves stores that sell hearing aids, where an audiologist tests for hearing loss and then may recommend a solution that can cost anywhere from $500 to $6,000.
The fine line separating professional care from conflict with commercial activities is a difficult one to tread — for both patient and practitioner.
That’s because, when the CPSBC position on conflict of interest is applied across the board, it becomes clear that commercially based practitioners are also “in a position of power and confidence over the patient.”
In other words, most patients can only trust that a given practitioner is competent and will recommend only what a client needs, rather than a more expensive solution that might improve the store’s bottom line.
Two of the largest eyewear chains in the Lower Mainland are not even BBB-listed.
Now that’s some kind of trust, especially when a significant and growing percentage of patients, clients, customers — call them what you will — are seniors or others with chronic health conditions.
In the early 1960s, when public healthcare was a topic of international interest, the overlapping relationship between CPSBC registrants and other eye-care professionals was the subject of many discussions.
At issue was the concern that opticians and optometrists were at risk of conflict because their stores engaged in both diagnosis of a person’s eyewear needs and sale of the eyewear itself.
Since that time, provincial governments have conducted substantial quality assurance reviews and healthcare legislation has undergone several updates. Today, professional relationships are more clearly defined and are a more comfortable fit one with another.
At the commercial level, however, patients are still faced with the responsibility of performing due diligence. Somehow, they must decide for themselves whether or not a given professional is sufficiently separated from the profit-making arm of a business as to put their patient’s interests ahead of their own.
That the trust is not always rewarded has been the subject of more than one television mini-documentary — albeit not as balanced or in-depth as we might like.
We’ve all seen stories that relate cost-of-production numbers for eyeglasses versus the profit-margin realities of retail prices.
So when I first tried to discover hearing-aid prices for this story — “just a low to high range, please; I don’t need the details” — I was not surprised I could not get past the receptionist unless I was prepared to undergo pre-test evaluation, hearing tests and product selection.
Yet when I approach a retail pharmacy to ask for comparative prices between generic drugs, brand-name and a medication with added nutritional benefits, I have no problem accessing the information.
Is it that some healthcare “stores” are reluctant to expose their prices for fear of being undercut by the competition?
If so, why does this situation continue to be the norm with respect to healthcare-related products that, for some, are essential to the comfort of daily living?
As patients, we should demand transparent, airfare-style disclosure regulations.