A physician practices oncology in a suburb 15 miles outside of a large city. She presently refers patients in need of special imaging studies to one of two centers in the city depending on the patient's home location and medical history. Recently, a respected radiologist informs the physician that he has joined a for-profit imaging center with the latest equipment and technology. The company is considering opening a new location in the physician's area. The radiologist states that this center would provide the highest quality of care and that an opportunity now exists to invest in this new center. He adds that more local investors will increase the likelihood that the company will locate their new center in the physician's suburb. The physician is interested in investing in the new center.
Which of the following most accurately describes the conflict of interest regarding the physician's referral practices and potential investment in this center?

Question

A physician practices oncology in a suburb 15 miles outside of a large city.  She presently refers patients in need of special imaging studies to one of two centers in the city depending on the patient's home location and medical history.  Recently, a respected radiologist informs the physician that he has joined a for-profit imaging center with the latest equipment and technology.  The company is considering opening a new location in the physician's area.  The radiologist states that this center would provide the highest quality of care and that an opportunity now exists to invest in this new center.  He adds that more local investors will increase the likelihood that the company will locate their new center in the physician's suburb.  The physician is interested in investing in the new center.
Which of the following most accurately describes the conflict of interest regarding the physician's referral practices and potential investment in this center?

Quizplus · Accepted Answer

Trust in the medical profession demands that even the appearance of conflict of interest be avoided. A primary responsibility of physicians is to ensure appropriate medical therapy and prioritize patient interests regardless of the impact on the physician's own practice, financial arrangements, and investments. Referral to a radiology center in which the physician has invested represents a financial conflict of interest as there is potential for financial incentives to influence the physician's medical judgment (consciously or unconsciously). Studies have demonstrated that self-referral can result in the overutilization of imaging. The physician's investment should be disclosed and patients given the opportunity to seek care in an independent facility. (Choice A) It is not illegal for the physician to refer to the center; however, her investment should be disclosed. (Choice C) It is not clear that the new center would provide a higher quality of care not available elsewhere. Regardless, the physician should disclose her investment in the center and provide the patient with all local options. (Choice D) Although the physician should provide referrals to other radiology centers as well, this does not substitute for her obligation to disclose her investment. (Choice E) It is important that the physician does not overtly influence the patient by preferentially recommending the center. However there is also the potential for unintentional coercion through verbal statements or body language. The conflict of interest still exists, requiring disclosure. Educational objective: Objective clinical judgment can be unconsciously clouded by financial incentives. Any actual or apparent financial conflict of interest must be disclosed and patients given the opportunity to seek care in independent facilities. __________ References: Turf wars in radiology: updated evidence on the relationship between self-referral and the overutilization of imaging. (http://www.ncbi.nlm.nih.gov/pubmed/18585657) Effect of physician ownership of specialty hospitals and ambulatory surgery centers on frequency of use of outpatient orthopedic surgery. (http://www.ncbi.nlm.nih.gov/pubmed/20713924)

A Physician Practices Oncology in a Suburb 15 Miles Outside