Fee Splitting: An Unethical Practice

Sunday 27th June 2009 HCFI: Sunday Medical profession has a defined code of ethics, one has to govern. One has to work within the legal and ethical framework, said Dr Aggarwal President Heart Care Foundation of India and Director IMAAKN Sinha Institute.

Under Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations Act, 2002, (6.4.1) a physician shall not give, solicit, or receive, nor shall he offer to give solicit or receive, any gift, gratuity, commission or
bonus in consideration of or return for the referring, recommending or procuring of any patient for medical, surgical or other treatment. A physician shall not directly or indirectly, participate in or be a party to act of division, transfer, assignment, subordination, rebating, splitting or refunding of any fee for medical, surgical or other treatment.   This also applies to the referring, recommending or procuring by a physician or any person, specimen or material for diagnostic purposes or other study work.
Under American Medical Association Code of medical ethics (6.02) payment by or to a physician solely for the referral of a patient is fee splitting and is unethical. A physician may not accept payment of any kind, in any form, from any source, such as a pharmaceutical company or pharmacist, an optical company, or the manufacturer of medical appliances and devices, for prescribing or referring a patient to the said source. Also referrals to healthcare facilities, clinics, laboratories, hospitals, or other healthcare facilities that compensate physicians for referral of patients are engaged in fee splitting, which is unethical. Healthcare facilities should not compensate a physician who refers patients there for the physician’s cognitive services in prescribing, monitoring, or revising the patient’s course of treatment. Offering or accepting payment for referring patients to research studies (finder’s fees) is also unethical.
Sexual Relationships with Patients
Monday 29th June 2009: Sexual relationships with patients are unethical and may compromise patient care. The effects of physician-patient sexual contact are almost always negative or damaging to the patient. Patients are often left feeling humiliated, mistreated or exploited, said Dr KK Aggarwal President Heart Care Foundation of India and Director IMAAKN Sinha Institute.

Medical Council of India (MCI) does not deal with the issue in detail but concludes that an improper relation, association or conduct between the patient and doctor is unethical.

Physicians and patients may be genuinely attracted to each other. However, any relationship in which a physician might take advantage of the patient’s emotional or psychological vulnerability is unethical.

As per the American Medical Association’s Council on Ethical and Judicial Affairs
1.       Sexual contact or a romantic relationship concurrent with the physician-patient relationship is unethical
2.       Sexual contact or a romantic relationship with a former patient may be unethical under certain circumstances. Sexual or romantic relationships with former patients are unethical if the physician uses or exploits trust, knowledge, emotions, or influence derived from the previous professional relationship.
3.       Education on the ethical issues involved in sexual misconduct should be included throughout all levels of medical training
4.       In the case of sexual misconduct, reporting offending colleagues is especially important.