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Luxury Primary Care and Academic Medical Centers: The Erosion of Science and Professional Ethics. Martin Donohoe. Academic Medical Centers. Evidence-based medicine Ethics Providers of last resort to poor and destitute, un- and under-insured Personal experience – university vs homeless clinic.

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luxury primary care and academic medical centers the erosion of science and professional ethics

Luxury Primary Care and Academic Medical Centers:The Erosion of Science and Professional Ethics

Martin Donohoe

academic medical centers
Academic Medical Centers
  • Evidence-based medicine
  • Ethics
  • Providers of last resort to poor and destitute, un- and under-insured
  • Personal experience – university vs homeless clinic
financial crisis responses
Financial Crisis:Responses
  • Increasing links with pharmaceutical and biotech industries
  • Recruitment of wealthy, non-US citizens
  • Luxury primary care / executive health clinics
luxury primary care executive health clinics
Luxury Primary Care/Executive Health Clinics
  • Most major academic medical centers
  • 2000-3500 visits per year
  • $1500 to $20,000/visit
    • Avg. $2000-$4000
lpc clinic perks
LPC Clinic Perks
  • Same day appointments/tests, accompanied consults, vaccines
  • Shorter waiting times
  • Low physician/patient ratios
  • 24/7 access, house calls
clients marketing
Clients/Marketing
  • Large corporations
    • Tobacco companies, environmental polluters, health insurers
    • Hope for contracts for institution/providers and/or corporate donations
  • Marketed to the “busy executive”
    • Mostly white males
unknowns
Unknowns
  • Medical student/resident participation
  • Effects on physicians
  • Effects on old patients
  • How funded
  • Where profits go - ?cross-subsidization?
  • Secrecy
lpcs and the erosion of science
LPCs and the Erosion of Science
  • Tests not clinically indicated or cost-effective
    • CXRs – lung cancer
    • CT scans/stress ECHOs – CAD
    • Pelvic US – ovarian CA
    • Whole-body CT scans
      • radiation~Hiroshima, raise cancer risks
consequences of unnecessary testing
Consequences of Unnecessary Testing
  • False positives → further testing, complications, anxiety, ↑ profits
  • Diversion of limited resources – human and capital
  • Erosion of evidence-based practice
    • Unsound science
lpcs and the erosion of professional ethics
LPCs and the Erosion of Professional Ethics
  • General public subsidizes medical training
  • Physicians limit practice to wealthy
    • Increasing differential of care between poor and wealthy
  • Financial factors replace clinical judgment
contemporary health care
Contemporary Health Care
  • ↑ wealth disparities
    • 20-25% of US children live in poverty
  • ↑ environmental degradation (and related illnesses)
  • ↓access to care
    • 45 million uninsured in US, underinsured, dead end jobs
  • Disparities by social class / race in access to and outcomes of care
  • Developing world brain drain; medical tourism
lpcs and the erosion of professional ethics1
LPCs and the Erosion of Professional Ethics
  • Workups, treatments based on ability to pay
  • Ethics
  • Rationing
  • Acceptance of double standard
lpcs and the erosion of professional ethics2
LPCs and the Erosion of Professional Ethics
  • Increasing cynicism/dissatisfaction among medical students/residents/practicing physicians and patients
  • More providers willing to “game the system”
solutions
Solutions
  • Renunciation of the measure of the marketplace as the dominant standard and value in health care
  • Equitable division of resources
solutions medical education and ethics training
Solutions: Medical Education and Ethics Training
  • Increasing emphasis on social, cultural, economic and environmental contributors to health and illness
    • Health disparities, cultural competence, occupational and environmental illnesses (e.g., pesticide-related illnesses, air pollution and asthma)
solutions medical education and ethics training1
Solutions: Medical Education and Ethics Training
  • Heal schism between medicine and public health
  • Service-oriented learning, research-based activist courses, volunteerism, political activism
  • History, literature, role models/mentoring
solutions public policy
Solutions: Public Policy
  • ↑ education of public policymakers (business leaders, government representatives, and health care purchasers)
  • ↑ public education
solutions public policy1
Solutions: Public Policy
  • Deans, department chairs, division chiefs, ethicists, doctor-patient
    • Ethicists quiet re LPCs
  • Outcome: ↑ funding for education, training, and care of the underserved by academic institutions
references
References
  • Donohoe MT. “Standard vs. luxury care,” in Ideological Debates in Family Medicine, S Buetow and T Kenealy, Eds. (New York, Nova Science Publishers, Inc., 2007). Available at http://phsj.org/?page_id=22
  • Donohoe MT. Elements of professionalism for a physician considering the switch to a retainer practice. In Professionalism in Medicine: The Case-based Guide for Medical Students, Editors: Spandorfer, Pohl, Rattner, and Nasca (Cambridge University Press, 2008, in press).
references1
References
  • Donohoe MT. Luxury primary care, academic medical centers, and the erosion of science and professional ethics. J Gen Int Med 2004;19:90-94. Available at http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1525-1497.2004.20631.x
  • Donohoe MT. Retainer practice: Scientific issues, social justice, and ethical perspectives. American Medical Association Virtual Mentor 2004 (April);6(4). Available at http://www.ama-assn.org/ama/pub/category/12249.html
contact information
Contact Information

Public Health and Social Justice Website

http://www.phsj.org

[email protected]

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