Maybe it’s because we have entered the silly season with a full cast of presidential aspirants, but I have recently mulling over the perception of behavioral impropriety. To translate from spin doctor to medical doctor, I mean professional behavior that may not be overtly unethical, but exudes self-interest over patient well-being. In the academic world, full disclosure includes financial interest with potential conflict, disclaimer of previous publications, responsibility for informed consent and approval by the appropriate research committee. In our practices, particularly in the clinic or hospital setting, much focus is on constructing a firewall between the pharmaceutical and the medical-device sales force and medical providers. At the institution from which I retired, I was spared the temptation of allowing beef fajitas lunches and free corporate writing instruments from influencing my practice patterns as these individuals’ access required pre-approval and donning brightly colored jump suits for stigmatic identification. These restrictions seemed ludicrous, and quite frankly, insulting to my professional integrity, but there is another area where I think reconsideration of ethical standards needs reexamination, and that is philanthropy.
The generosity of private individuals to medical institutions provides critical support for research, education, and physical facilities. These benefactors do not appear deus ex machine; they must be identified, pursued, and informed as to need and benefit. That is the purported reason for development offices and officers. However, the rubber meets the road most often when donors were once patients and, as patients, were treated by physicians. So are there guidelines for physicians’ behavior as solicitors just as there are for medical practice? What role should we play?
The most altruistic of us may decry any role as crass and debasing our pledge to the Hippocratic Oath. Wooing donors takes time from patient care and could lead to self-serving ends, diverting resources towards personal use without regard for institutional need and may require preferential treatment of the few at the expense of the many. But not many of us are so narcissistic as to triangulate donor vs. institution for personal gain, and most extra attention for a particular patient adds to our workload, not to short-change others. Some institutions have established some guidelines whereby the role of physicians and the development office are outlined and physicians can participate as he or she feels comfortable; there is no penalty for abstaining. This is neither a widespread practice nor are the rules clearly outlined and part of medical staff indoctrination.
Some may wonder whether I am making much ado about nothing; however, philanthropy is necessary for the fiscal viability of our medical institutions. To the best of our ability and willingness, we should promote the generosity of those able to do so, and let us do it without taint of self-interest. Let’s just look to our representative government for guidance.
By Norman Silverman, MD, with Ryan McKennon, DO and Ren Carlton