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Are the ethics of healthcare compatable with the ethics of business?

Healthcare providers need to be profitable to serve patients. But, the interests of the patient are primary over the interest of profits. Are the two co-exist?
Is physician entrepreneurship a contradiction in terms?

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    Jan 22 2014: i'm not aware of different ethics for different fields. i think ethics is ethics, let it be business, healthcare, friendship, father and son relationship, whatever.
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      Jan 22 2014: Would be the way to practice some peace in our mad society. We think in the same direction, Kriszian.

      Thank you :)

      However, people still need to agree upon some basic ethics that would be workable….
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        Jan 22 2014: surely in some cases, but we also don't have to in other cases. we need to agree on how to use a river, many people affected. we don't have to agree on what i eat, it is my decision.

        but certainly, it is time for us to discuss what is ethical. and to get to somewhere, i suggest dropping such silly notions that "business ethics vs healthcare ethics". we need to focus on the individual. deciding questions like "what level of inflation is the best" is next to impossible to do. we always have to go down to the individual, and judge actions. if an action, in itself, is ethical, or acceptable, we should not condemn it because it goes against some high level principles. if principles disallow otherwise commonsensically ethical behavior, the principle is defective, and should be discarded. we are bad at judging principles. we are good at judging individual actions. (okay, maybe not good, but better.)

        i kinda like this talk: http://new.ted.com/talks/barry_schwartz_using_our_practical_wisdom
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          Jan 23 2014: You've said it - "we need to focus on the individual."

          It's a very forgotten approach/thinking - in our "robotic" society of industrial games. I just published my long post. Please read it and let me know what you think, if you have a few minutes.
  • Jan 22 2014: Do patients have any ethical responsibility to optimize scarce healthcare resources in any of this? Or, are they just lemmings being led to slaughter by greedy capitalists and physician entrepreneurs who take advantage of unknowing prey?
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      Feb 4 2014: Hi Dr. Meyers,

      Thank you for your insightful, timely, and highly relevant questions. These are the questions I'm asking myself as a patient or consumer of healthcare. Most of the time, I feel just like a lemming as you mentioned.

      What can we do about this?
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      Feb 9 2014: Arlen, We are talking about a salad which is comprised of apples and oranges. First the apples: The Hippocratic Oath binds the doctor to provide care to the best of his ability swearing to medical honesty. The oranges: The cost of doing business. The realities are that medical practice is very expensive ... in terms of education, facilities, equipment, personnel, insurance, and all of the other "costs".

      So as the salad cannot be made with out each of the two ingredients nor can the physician serve his patients without the necessities of "doing business".

      Laws passed that says a hospital must treat all who request services have cost the medical profession dearly. As the federal government has refused to protect our boarders the illegals have found that they can go to emergency rooms and get treatment with no means or cares about payment ... this means that there are approximately 11 million who can get "free" care. The private practice also has dead files that must be absorbed ... insurance companies deny claims or seriously reduce the payment for treatment ... Now there is Obamacare which has the force of law to question and deny medical opinions. Oops, I forgot it is a TAX that can question medical opinion. ACA can also set payment limits which would further reduce the income of the doctor. All of this to obtain a goal that both Hillary and Obama proclaimed ... sole source providers. Socialism in action. Worked so well in all of the other third world countries why not do it here .... As Nancy Polosi stated ... First lets pass it and then examine it .... That happened and in the light of day the problems are glaring and damning.

      I looked up ethics: ethics, also called moral philosophy, the discipline concerned with what is morally good and bad, right and wrong. ... A person is either ethical or not .... by having two professions or ten the answer remains the same ... good or bad .. right or wrong.

      I wish you well.
      • Feb 9 2014: Illegal immigrants represent about 2 % of ER visits
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          Feb 9 2014: I just did a quick search and cannot find anything which substantiates your statement that 2% of ER visits are illegal immigrants Arlen. Could you please provide a link to where you got that information? Thanks
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          Feb 9 2014: Out of the 2000 characters I wrote you only heard about illegal immigrates ....

          Sorry to have wasted your time .... Bob.
      • Feb 9 2014: We should be celebrating physician entrepreneurship. I don't mean price gouging or ripping off patients. I mean adding patient defined value through the deployment of innovation.

        We need to eliminate the unintended barriers and give patients the tools they need to be better patient customers...transparent outcomes and prices, an incentive to spend carefully, better ways to partner and communicate with care teams, etc.

        Medicine is no lonter a doctor taking care of a patient. It's a care team taking care of a patient's team or community.
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          Feb 9 2014: I wholeheartedly agree Arlen, that the practice of medicine can be a "team" endeavor. I consider the medical professionals involved with my health care as a team, and I am the captain of the team.

          In order to be on a team, we each have to do our part. We can "give patients the tools they need....", and if a person does not know how to use those tools, they are the same as they are without the tools. In order to communicate with care teams, a person needs to have information about their own body/mind functions, and that seems like something some folks don't want to explore.
  • Jan 18 2014: We've had the experience of choosing between not-for-profit (which I believe is total BS) and non-profit hospice care for a family member. There is a myth that capitalism improves everything. We saw how the not-for-profit sparingly doled out services. For what? Presumably to preserve the salaries of the providers not to preserve resources for the community. If we can, we'll choose a non-profit hospice every time. To me, there is something immoral about profiting from dying. (PS - I believe the same for funerals so I am glad my family member chose cremation.) To me, the problem lies with sustainability. The high salaries of hospital administrators, health care insurance administrators, equipment manufacturers, etc. cannot be sustained. There is no real competition. Its more like a cartel between providers.
  • Feb 7 2014: Ethics is a wrong concept in healthcare. If we have to spend million dollar to save a baby that will need life time of care? What will be ethical choice? To let baby die?

    We need to set a parameter on what society can afford and what individual can afford. Business is there to bring innovation and efficiency to the table and then have clarity on their operation and charges. If they are unfair they will go our of business. It will be value judgment call on the part of society.

    Society need to be trained so that at some point "NO" is acceptable even if it means death. There are competing choices on efficient spending of resources
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      Feb 7 2014: This has already been addressed by the 4 pillars of ethics: autonomy; beneficence; non-maleficence; and social justice.
      Justice is the pillar that ensures the extent to which resources are utilised are in keeping with the ability of society to sustainably and easily repeat the exercise without burdening the system on the whole. The scenario you describe is only possible in a private healthcare system where individual resources of parents can 'command' the system to unethical depths.
      • Feb 7 2014: Sumesh:

        Thank you.
        My impression is that it happens with Government support at child birth and end of the life in Medicare all the time. I am not sure what will happen in Obama care. Issue is unresolved. 20 % of hospitalization consumes 80 % of resources. Society has not resolved when death is acceptable.May be I am wrong.
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          Feb 7 2014: I'm not sure where you get the 20% 80% relationship from, but I don't agree with it.
          Medicine has resolved when death is acceptable. The details are available if you search for EOL care and protocols (end of life care). Futility is a specific and defined term and specific criteria must be met.
          The field of medicine is quite clear on many issues that society claims it needs clarity on.
          Sadly it is commerce that comes in and creates confusion by inciting greed and inequality.
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    Feb 3 2014: "The etymology of 'business' stems from the state of being busy, and implies commercially viable and profitable work." Wikipedia

    Heathcare is one form of business. In fact, it is one of the most profitable businesses. People who work for clinics and hospitals, i.e. healthcare admininstrators, doctors, nurses, and medical technicians are some of the best compensated workers and their positions are some of the most stable. People get sick and need healthcare all the time. Healthcare business is not seasonal, unlike some other types of businesses.

    Ethics, good business practices, and good customer service are expected regardless of the type of service or business. These are even more critical in the business of healthcare, where some cases are a matter of life and death.

    Good medicine and good business practices are compatible. To succeed in healthcare business, one has to practice good medicine and good customer service, including not gouging your patients just because you can.

    MD and MBA should not be contradiction in terms.
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      Feb 6 2014: And how do you achieve that when the human is a biological creature driven not only by compassion and altruism but also by instinctive physical desires, emotion, lust, anger, greed etc.
      Sadly we will never be rid of these qualities and they will always invade the 'busy' venues we interact in.
      This is alright when life is upheld, but when you could lose your life, or suffer interminably then I refuse to accept your syllogistic simplification of medicine. Medicine was a field DEVELOPED by compassionate and altruistic minds to actively perform the duty of helping our fellow humans without discriminating between economic classes.
      It Transcends all other form of commercial activity to allow itself the stature of being business that is not the slave of commerce.
      It is ok for a trader to refuse you processed food since it is possible for you to grow your own. Therefore payment for staple food may be contentiously regarded as acceptable. But if you are in severe pain, or you have been knocked by a bus and cannot breathe, then to insist on payment first is beyond inhuman.
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      Feb 7 2014: I agree Rodrigo, that health care is a business, and like all businesses, it depends on how it is managed. So I agree that good medicine and good business practices are compatible

      You say...
      "Ethics, good business practices, and good customer service are expected regardless of the type of service or business. These are even more critical in the business of healthcare, where some cases are a matter of life and death."

      If the business part of health care is not managed well, it often contributes to compromising the health of the customer. If the "managers" of health care are simply looking at the bottom line and profit, they may not be aware that the profits may be at the cost of the care they are providing.

      We had a good example of this locally years ago with the big teaching medical facility in the area. It was once on the top ten in the country for good care. The board of directors were apparently looking primarily at the bottom line profit. They decided to redecorate the lobby, at the cost of a couple million dollars, and at the same time, they were decreasing the nursing staff by about 300 nurses. A lot of people, including myself were appalled at this, and it certainly was not the only poor decision the directors made, but it was a very public one.

      I had a relative and friends who were patients in the facility at the time, and it was VERY clear that there was a shortage of nurses, as the construction for the new lobby was happening. As I said, there were a lot of other very poor decisions, and finally, there was so much public outcry, most of the members of the board of directors were terminated. There was a legal matter with the chair of the board as well, regarding money he accepted from contractors.

      On the other side, my doctor and her husband have a small practice in a small town and don't make a lot of money, while providing health care to a small community. I would say that an organization like doctors without borders is in this category as well.
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        Feb 7 2014: Thanks for your insightful testimony, Colleen. We need a peaceful revolution or, at least, constructive evolution in healthcare, education, and public administration.
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    Jan 24 2014: Business and healthcare have compatible ethics only to the extent that there exists a positive correlation between healthy workers and profitable businesses.
  • Feb 17 2014: i disagree with the first sentence: healthcare providers do not need to be profitable to serve patients. They only need to make payroll and cover expenses.
    Medical care should not be a profit focused activity. It is unethical to make a profit off of sick and dying people. People who do this are vultures not doctors.

    It seems to me the biggest problem is that insurance creates huge pools of money which allows healthcare providers to charge extremely high prices. Prices are completely out of control.
    The only solution is to eliminate the huge pool of money, i.e. get rid of insurance plans and go to cash based payments only. That would limit usage and lower prices.

    However under the new ACA more people are required to have it.
    This will cause prices increase since more money will be available.

    I'm in favor of private physician practice and for eliminating the AMA which controls the number of physicians thus keeping salaries extremely high.

    One problem in the U.S. is the wolves are in charge of guarding the sheep.
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    Feb 9 2014: Thanks:

    1. All professional people were on time for you!
    2. sharing your Story.
    3. It is very nice to meet you at the TED conversation”.

    Best Wishes for You, every day that will be peaceful and content. Colleen.
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      Feb 9 2014: Thank you very much Lamb Lamb......I appreciate you and wish you every day peace and contentment:>)
  • Feb 9 2014: Until the medical and health professions (and any parasitic "hangers-on" including politicians and regulators) have a profitable incentive to provide wellness and disease prevention services, they will keep on being motivated to have the patient return for more sales. Where is the incentive to teach "self-responsibility" to keep the patient away from the doctor?

    Business schools teach that an existing customer is more profitable than finding a new one. So in the sickness industry (not health), it is better to have a sick customer remain a sick customer and return for regular checkups and prescriptions. There is no incentive for anyone who makes a living from the diseased and sick to do themselves out of a job. The system that bows to the power of the big players is the reason why the medical system itself is now the largest killer, and the various "wars" (eg "war against cancer") will continue to be a farce. The World Economic Forum in 2011 stated that most western health systems will be bankrupt by 2030. They also stated that most non-communicable diseases are lifestyle related (nutrition, exercise, etc).

    Until there is a change of consciousness and a leveling of the playing field so that we start to focus on lifestyle wellness factors (including funding scientific research into these areas), the problem will continue to grow. You do not need to go back far in history to find examples of how some people kept healthy without pharmaceutical or medical interventions. Our biological systems genetically evolved from hunter-gatherers. They have not had time to adapt to the onslaught of toxins from excess consumption, modern food systems, industrial chemicals and pharmaceutical drugs.

    There are some parts of the world where natural plant medicines and alternative practices exist and are used in parallel with modern medicine (eg plant medicines from the Amazon, dry fasting in Russia, nutrition).
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      Feb 9 2014: Good points John....."self-responsibility"! I agree that there is not much incentive to learn better ways of taking care of ourselves, when drugs are readily available to "fix" our discomfort!

      I agree that a change of consciousness is needed with individuals and health care providers, and the challenge seems to be to encourage folks to be aware of the mind/body connections, how they work, and how we can keep ourselves more healthy. I strongly agree with you that it is good practice to use all available resources, and that requires KNOWING and LEARNING about all available resources and how they work with our body/mind.
  • Feb 6 2014: Doctors are people like you and I. Not saints. The organizations they work with are run by people. Not saints. Their reputations are determined by the experience of the local people not bureaucrats in Washington. With private health care you can choose to tell all of your friends of this organization`s shortcomings and never go there again You can seek legal redress for any wrongs against you through the courts. These options would be lost for you under government health plans..
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    Jan 25 2014: This question asks about ethics and not morals, and while they are both concerned with right vs wrong, ethics relate to formal rules provided by an official body of people, whereas morals refer to an individual's beliefs. In responding to this question, I think we should be clear as to whether we are thinking about morals or ethics.

    When hospitals dump its poor patients onto the streets early to save money (see http://www.alternet.org/news-amp-politics/ca-sues-nv-dumping-mental-patients and also http://www.latimes.com/local/lanow/la-me-ln-patient-dumping-skid-row-20140103,0,7977084.story), that clearly shows the incompatibility between healthcare and business ethics.

    The Hippocratic oath is one of the first and most famous formalizations of healthcare ethics. It says very clearly, "Do no harm." It says that unconditionally. Not "Do no harm if you can help it." If you're dumping patients on the street, you are doing harm.

    Sidetrack: I just read one translation of the original Hippocratic oath - fascinating! Here's the first paragraph - wow, how far is this from reality today?!

    "To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art — if they desire to learn it — without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but to no one else."

    [From "The Hippocratic Oath" by Ludwig Edelstein]
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    Jan 23 2014: At least most businesses know when they are pricing themselves out of the market. Almost everyone is already saying that healthcare is going to bankrupt America, yet, it seems no one from the industry is listening. Health insurance and healthcare costs have been out of control for a long time now. Insurance is intended to make people feel secure in the event of serious or long-term illness but, instead, it has put a lot of us to bankuptcy and misery. These days, it seems ethics and healthcare have become contradiction in terms.

    Hello, is there anyone listening ... someone who truly cares?
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      Jan 23 2014: Here is a hope when a few intelligent individuals are already changing their OWN routine in practicing - independently from the systems.

      Krisztián Pintér shows this link - it's very encouraging

      http://www.youtube.com/watch?v=L9s6l9srzDU
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    Jan 23 2014: Our healthcare systems appear as grotesque and ugly as any social circus may ultimately become.
    Presently some goodhearted teachers and doctors cannot change existing systems because they are already insiders, Servants, and must obey their mindless, controversial rules.

    We are missing basic ETHICS in all schools as well, demonstrating unethical methods in teaching. Schools are Taming students to think as conventional units to get them prepared to serve large systems, industries, institutions and dogmatic religious institutions. This popular sort of "education" commonly create natural resistance among some young students, especially most talented. Some of the students might become dangerously desperate, fighting agains the systems later on .

    Unfortunately they have no idea that there are some wiser, more peaceful ways.

    I must say that All Large Systems/industries, and everyone who serves them, as well as many of us, who are involved as victims are already Unethical in every way, even towards our own selves.

    My goal in writing this very post is to suggest how we might change this nightmarish industrial "culture".

    I'd like to engage someone in this thinking.

    Well, perhaps it would be impossible to change or fight against gigantic systems - this might be costly, time-consuming and even bloody. I honestly do not see any need to do so!!

    My main thought - we have to invent and practice new Independent Small Systems which would be purposely designed to serve real individuals with their individual needs. It would be a more natural approach, beneficial economically, educationally and health-wise.

    These small systems can be designed after the idea of a Sustainable innovative community, for instance, we can build them as small enchanting villages, with gardens, a small bakery, restaurant, library and perhaps a club/theater. Can a school or a hospital be built after an enchanting resort, while offering meaningful New jobs and traditions?
  • Jan 23 2014: Hi Vera

    Regarding: "There are no truly thoughtful ethics possible until Both sides are ethical."

    Can't say I agree, as I have always maintained my own ethics, regardless of others determination to sidetrack them.

    As to "Never treat others as you would like to be treated yourself - unless they agree to it first - because what "works" for you may be damaging for others"

    I could not agree more; and as to the Golden rule of ethics, I have always felt that perhaps it should have been stated differently, which now given "your version", would seem to work well together

    "Do for others, that which you would want them to do for you"

    But

    "Never treat others as you would like to be treated yourself - unless they agree to it first - because what "works" for you may be damaging for others"

    However my own feeling has always been; "Do not do unto others, that which you would not have them do unto you".

    And it follows; "If others undeservedly do unto you, that which you have not, and would not do unto them, it is not acceptable behaviour.

    Cheers Carl
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    Jan 22 2014: Hi Vera,
    the ethics of those 2 fields were only compatible in historical China where doctors were assigned certain areas and they got paid for those people that were not (!!!) ill.
    In modern systems a healthy person does not bring any income. Successful practitioners thereby would become at one point bankrupt and that has to be avoided by any means.
    Like a friend of mine in Copenhagen had a business selling herbs (Urte was his surname which actually means 'herb' in Danish). One day we got told that he went on a 'trip' and left while his shop got sold by a lawyer. I have never seen him again. Though this doesn't proof anything, one gets into thoughts about it especially if one hears similar stories from other friends.
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      Jan 23 2014: This is a very ill-some "healthcare" situation in which we are all involved, more or less. Here, in the USA, that "healthcare" system and its pretentious "humane philosophy" appears as grotesque and ugly as any social circus may ultimately become.

      Why do Medical institutions and their doctors honestly Love to keep their patients ALIVE, and its is important for them to look so "helpful and humane" to their patients ? They do this for the wrong, unethical, reason.

      You have answered this painful question boldly - if patients are gone, die too soon, or get really well , it'll be no work, and no income for those healthcare systems.

      Therefore, medications/procedures do Not Help us Get really Well - the main purpose is simple - to Keep us Alive as long as possible, absolutely addicted to pricy medications. While we live in misery and pain, we are not getting much of a clarity - we feed a bunch of systems simply by staying Sick!


      Thank you, Tobias.
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        Jan 23 2014: Hi Vera,
        here in Germany it’s not different. Doctors are helpful. But what they are doing is patchwork and this has to be recognized. They are very good at patching somebody up, but they don't handle the cause of it. This is needed if somebody e.g. has a car accident or something like it so he doesn't die before the cause can be handled. But then they also prevent the cause to be handled.
        I forgot to mention in my earlier post that this friend had managed to cure a case of Aids and couldn't keep his mouth shut. Though he insisted on his 'treatment' not to know what his customer’s problem is. He only recognized on symptoms what the body is missing and sold that to the person. But then this customer came back and told her success, that she through all medicine from the doctors away and only took what he gave her.
        There are few people that still belief after all these years and money spent 'on research' that cancer is not curable, but Aids is still hot business.
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          Jan 23 2014: Tobias, Very grateful for sharing with your your stories.
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    Jan 22 2014: There are no truly thoughtful ethics possible until Both sides are ethical.

    In this respect I'd like to suggest to Replace the Old Golden Rule with this New one

    "Never treat others as you would like to be treated yourself - unless they agree to it first - because what "works" for you may be damaging for others"
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    Jan 20 2014: I don't think so, I am not a doctor, but I have come to know a few. So a doctor to practice medicine as an individual has to have help to provide those services... Clerks, nurses, others, there are offices spaces, equipment and supplies, utility expenses, insurances, school loans, taxes... the list goes on. So, the doctor needs to know what his costs are to provide services and therefore his charges to patients to meet those costs. Then he has to be in some sort of price range with other doctors. This same process is as it is with all business.

    There is no question of ethics.

    If a doctor or any business man fails to give service for value received, he will soon be out of business.
  • Jan 19 2014: Here in Europe health is considered so important that the goverment of most countries are responsible of taking care of all their citizens, not only of those who are wealthy.
    Heath is not a business and never will be. Is a human condition previous to the economy.
    So YES: medical entrepreneurship is a nonsense.
    • Jan 19 2014: That has been my experiance as well. We moved from Holland to Canada and seeing the difference, I call it the medical industry.

      Added:
      In my opinion it is only the government that can set and maintain/enforce the rules.
      Most European governments are socialistic, which means people come first and have to be protected against companies. I don't know about other countries, but in Holland there are hardly any unions and practically never any strikes.
      Well, i'm talking about the situation of 30 years ago..
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    Jan 18 2014: Without the funding from business and tax payers, health care would be hard to have at all, because it is very costly to preform the treatment that is needed, and it require that you have at least some profit. It would be amazing, if money wasn't the thing that runs everything, and it would create less conflict through out the world, but as it is greed is the root of everything in this world, and if money was were not the root of it something else would be.
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    Jan 18 2014: Physician entrepreneurship by itself is not a bad thing. Abuse of it is such as physicians over utilizing their own labs, diagnostics, etc,. If a physician group owns a hospital who cares if they make the profit versus a big company?

    The big companies are really the issue - the boards and investors of these companies make far more than the physicians.

    Here is the financial statement from HCA
    http://phx.corporate-ir.net/phoenix.zhtml?c=63489&p=irol-reports
    I would bet their BOD (all 20 plus) are all millionaires. VERY FEW of the physicians I work with are, even after 20 years of practice.
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    Jan 18 2014: Excellent Topic. I look forward to the thoughts that will out. I suspect we may find our demons are very much alive and well and wish us well as we proceed with the business of evolving.
    What I currently think is that we would like to live in a world where ideals reign supreme, but frontal lobe thinking is so very energy consuming that once we stop 'envisaging' and resume 'living', we suddenly feel these primitive competitive, survival urges taking control of our billing software, management strategies, course attendances, and perk-related medical purchasing patterns.
    Every now and then Professor Frontal Lobe gets a little jolt from a good night's rest and resolves to mend his wicked ways, but watching cognitively challenged bling-decorated unreconstructed homo sapiens drive past you in wickedly expensive sports cars somehow results in an instant frontal lobotomy and .... kerrchinggg!
    Financially, we currently require far less as a profession than we generally earn. I feel it is only natural to see oneself as a human being first and behave as nature intended. To do this unrepentantly requires us to extend the same courtesy to everyone else. This is not a good recipe for the maintenance and growth of a civilised society. The problem is it needs to be addressed in all professions at all levels, and I understand, despite taking exception to, societies vilification of doctors.
    It is imperative we push ahead the humane agenda, insisting on fair and equitable healthcare sans the standard supermarket business model. But we must not just engage in the increasing practice of humane and fair healthcare delivery, but also actively protest at other sectors that fly under the radar yet remain sickeningly unethical due to the focus being on doctors.
    I refer to hospital and managed healthcare business-persons, politicians, pharmaceutical companies, subscription journals, academic researchers, etc.
  • Feb 17 2014: Quite simply cutting to the chase

    Is it wrong or right, to profiteer off the sick and dying, yes or no

    And putting aside all excuses and academic arguments, that is a matter of conscience; which quite clearly as the massive profits of the health Corporations serve to define, they do not possess
  • Feb 17 2014: The ethics of human being always are differs from human to human which means human ethics in health care or in business will be changed from one to another this will lead the concept of "Health Care For Patients" or "Business Of Health Care" are carried by human "Doctors, Nurses, ... and so on" will not be compatible in every and each case, so we are going to something like "Standards" to try to measure "The Ethics" scale between the business and the service.
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    Feb 17 2014: /
    Physician entrepreneurship is a contradiction of ethics orientations, not terms. Fairness or ethics for each has a different center of gravity even though ethics for each is basically the same thing: ethics, seeking to do the good, is about doing no harm and finding a healthy thriving outcome for patients for physicians, and at the same time in business it is doing the prime good of growing your business, profit margin, market share without unfairly disallowing others to be financially successful as well. A good business person does no harm as part of being a good person but that directive does not take center stage as a constant center of focus. If the patient is under my knife I am likely to be acutely aware of every choice in the light of possible harm. If I am removed from the patient, as a pharmaceutical business person, I may see opportunities to do good without seeing possible harm as clearly.

    Profitability may accompany but does not correlate with nor cause quality of care.

    good question
  • Feb 16 2014: Given current industry I don't think that there is an industry wide way to make this happen. Why is it that insurance companies get far different rates for medical services than someone with cash? I have seen multiple examples of people getting the short end of the stick when they are not covered while health insurance companies are getting price breaks all over the place. I understand the business aspect of this model and am intrigued by the cash flow but in an industry where compassion and humanity should be priority number one the profit margins seem to win out.
  • Feb 11 2014: Larry alludes to the difficulty in making the hard decisions needed to reform healthcare, whether private vs. public or corporate vs. entrepreneur. Defining the terms clearly demonstrates the impractically of expecting morality to dominate decisions regarding the allocation of any scarce resource.

    Our system's failure to keep costs competitive with other developed countries is the result of politically savvy 'haves' demanding Cadillac coverage even though it forced the cost of providing treatment for to large group of uninsured to spiral out of control. If we admit resources consumed must be more important than morality of allocation of service, tough rules must be agree upon ......... and enforced.
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    Feb 11 2014: I simply do not favor ethics as defined in an association of healthcare and business. Business sense of what is right and wrong seem to change as a matter of convenience. The goals of healthcare and business do not run parallel but you got to have a business presence in healthcare. I would favor physician entrepreneurship on a sound foundation of integrity clearly defined.

    eth·ic noun ˈe-thik

    : rules of behavior based on ideas about what is morally good and bad
    ethics : an area of study that deals with ideas about what is good and bad behavior : a branch of philosophy dealing with what is morally right or wrong: a belief that something is very important

    Full Definition of ETHIC
    1 plural but sing or plural in constr : the discipline dealing with what is good and bad and with moral duty and obligation
    2a : a set of moral principles : a theory or system of moral values —often used in plural but singular or plural in construction
    b plural but sing or plural in constr : the principles of conduct governing an individual or a group
    c : a guiding philosophy
    d : a consciousness of moral importance
    3 plural : a set of moral issues or aspects (as rightness)

    in·teg·ri·ty noun in-ˈte-grə-tē

    : the quality of being honest and fair
    : the state of being complete or whole

    Full Definition of INTEGRITY
    1: firm adherence to a code of especially moral or artistic values : incorruptibility
    2: an unimpaired condition : soundness
    3: the quality or state of being complete or undivided : completeness
  • Feb 10 2014: Does any healthcare program around the world deny joint replacement based on age or obesity etc.?
  • Feb 10 2014: Does any health care program limit the availability of artificial joints based on age?
  • Feb 10 2014: Do countries offering 'socialized medicine' use the all too frequent 'wait' for availability of an expensive procedure to reduce the number of operations and thus total cost to the 'system'? This would seem a logical way to avoid the 'unethical' decision mentioned by Henry. This would be more difficult to rationalize when expensive drugs are 'available'.
  • Feb 10 2014: The ethics of health care and the ethics of business have a considerable overlap. If a physician knows a patient can be returned to functionality by a very expensive procedure but also knows that there are thousands of others who also need this procedure and the money isn1 there what should he ethically do? Should he tell the patient "We could help you but we don`t have the money." or would that be unethical. The ethics of health providers is necessarily very cruel at times. The money necessary to help that patient might well be enough to send several young people to college.
    Business ethics present a much less critical problem.
  • Feb 10 2014: Thanks Colleen, I have come to the conclusion (at age 63) that there has been virtually nothing in my life in terms of illness or disease that couldn't have been mostly fixed with fasting, good nutrition and exercise. And that includes knowing that I have a genetic predisposition to obesity, heart disease, diabetes and inflammatory diseases like arthritis. I admit that I have not had any broken bones or been in a serious life-threatening accident. But even if I had, I now believe that regular fasting (especially dry fasting) - like a hunter gatherer would have naturally done - rather than normal medical treatment would have accelerated the recovery. For example, it has now been scientifically proven that fasting is very beneficial for head trauma. It probably would have been better to heal my knee that had a cartilage removal in 1970 (and then caused arthritis and lower back problems - partly because it was botched surgery). Dr Joel Fuhrman, a nutritional medicine doctor, cured a serious heal injury with fasting rather than surgery (an elite athlete - the injury put him in a wheel chair). Fasting also up-regulates autophagy (cellular self-digestion) which is a biological process that is dis-regulated in Alzheimer's and Parkinson's. It also lowers homocysteine, a chemical component associated with most neuronal diseases (including depression) and cardiovascular disease.

    Given that such an approach is so beneficial, why hasn't there been more funded research done on it? You can say it is because there is no profits for external parties in self-responsibility. But taxpayers pay a very large slice of the national health bill, so a lot of those costs would be saved if we had more education, encouragement and incentive to heal ourselves. The weakness in the system, therefore, seems to be at the political and legislative level. Research funds should be made available to treatments that don't offer potential profits, but still offer cost savings.
  • Feb 9 2014: "We can reduce cost of education and increase number of doctors and it will reduce the cost"

    . How would increasing the number of doctors reduce the cost? Cost to each patient or cost to the system as a whole?
  • Feb 9 2014: Patients vs Profit is not the issue.. Would you ask that question about Ball players, stock brokers, actors,drug makers?

    It is not only expensive to be doctor but requires higher degree of drive, commitment and training period. It falls right into our economic value systems. Society has a opportunity to reduce medial cost. We can reduce cost of education and increase number of doctors and it will reduce the cost. We have efficiency and other structural problems that we can resolve to lower the unit cost. We can educate patients to use medical services judicially. We can increase child mortality and lower life span of older non productive people.

    One of the greatest disappointment of ACA was failure to deal with cost and practice and other issue I indicated above. I want first grade steak at best restaurant at low price. Our economic system do not allow it. TO hype a issue for false diagnoses does nto advance solution.
  • Feb 9 2014: Patient portals and digital health platforms will make your experience better and hopefully less costly. Physician entrepreneurs make it happen
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      Feb 9 2014: And according to your profile, you just happen to be the President and CEO of the Society of Physician Entrepreneurs. It looks like you are promoting that Arlen.

      http://sopenet.org/sope-in-the-news/society-of-physician-entrepreneurs-helps-doctors-better-serve-patients-globally

      Physician Entrepreneurs facilitates bringing health care innovations to market, and it appears that you have misrepresented yourself and your intent Arlen, because you and your organization are more about business than health care.
      • Feb 10 2014: My intent in posting this question and moderating this discussion was to create a forum where we could discuss what I felt to be an important healthcare policy issue.

        The organization I am proud to lead is about innovation and getting ideas to patients. As a practicing surgeon, I try to place the interests of patients above profits but struggle, like most,with how to deal with conflicting interests most doctors face.

        Those that have taken the time to post and express their thoughts are free to judge whether I have misrepresented that intent or not.
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          Feb 10 2014: I think you have made your particular interests clear via your profile, as a professor of ENT and head and neck at the University of Colorado medical school, a practicing doctor, and an entrepreneur.

          I notice the article Colleen has helpfully linked has a typo in a quote attributed to you. You may want to ask the site to make the correction. It says "no irreconcilable" when you surely said "not irreconcilable."
  • Feb 9 2014: We;re getting off track discussing the amount of ER care for illegal immigrants (maybe another TED discussion?) but Emergency Medicaid is another complicating issue
    http://www.kaiserhealthnews.org/stories/2013/february/13/medicaid-illegal-immigrant-emergency-care.aspx
  • Feb 9 2014: http://cnsnews.com/news/article/while-there-are-about-12-million-illegal-aliens-us-today-cbo-estimates-senate-health
    in 2009., about 10%
    The number of illegals has dropped since then .
    ONe reference is the American College of Emergency Physicians
  • Feb 9 2014: Which people.? How would you hold the accountable?
  • Feb 9 2014: Moral hazard refers to the tendency for people to take cost free risk , like using healthcare resources as long as they don't "have to pay " for it
  • Feb 9 2014: Dr. Meyers,
    I would like to bring to light a recent clash of healthcare advancement and capitalist interest that perfectly serves this conversation. As of December 2013 the FDA has approved Sofosbuvir for the treatment of Hepatitis C. The drug has been hailed as a 'landmark advancement in the treatment of Hepatitis C" by the CDC. Sofosbuvir will eliminate the virus entirely in 90% of patients treated with the drug according to clinical trial data. Currently 3.2 million people worldwide are afflicted with chronic Hep C. This drug represents a triumph in the business of healthcare research as Gilead Sciences incentivized by profit potential has come close to curing a major source of human suffering.

    This major advancement, however, comes at a cost unbearable to all but the wealthy elite or third party payers who may or may not choose to cover it. The suggested price of this drug is around $1000 per tablet or $84,000 for the full 3 month treatment recommended. Pharma can choose to set prices on drugs however they see fit. We cannot simply call this an unethical businesses practice though without first considering that it costs an average of 1 billion dollars and 10 years R & D to bring a new drug to market through the FDA. Does the consumer mantra of "you get what you pay for" apply here or is big pharma majorly exploiting the ignorant masses? My personal contention is that business ethics and healthcare ethics are not compatible due to the fact that the human demand for healthy life and survival is insatiable and therefore gives too much power to the industry that supplies medical goods and services.
  • Feb 9 2014: What is the best way to remove the moral hazard?
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      Feb 9 2014: Arlen,
      What is the "moral hazard" when people are well informed?
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      Feb 9 2014: Arlen,
      This is a reply to your comment....
      "Moral hazard refers to the tendency for people to take cost free risk , like using healthcare resources as long as they don't "have to pay " for it".

      It goes back to responsibility and accountability for one "self". KNOWING ourselves and how the body/mind systems work, rather than blindly accepting what we are told.
  • Feb 9 2014: I'm surprised by the apparent confusing. The definition of 'success' for both health care providers and businesses must include 'satisfied', well treated customers, whether their patients or purchasers of other goods and services.. By definition, an unethical organization will fail to provide 'value' for whatever they do or make and so will eventually fail.

    This thing called 'value' has been clouded by third party payers (insurance company etc) who collect a little from everyone so 'a lot' can be paid for an accident or ailment to one of the group whenever they occur. Remembering the 'dog in the fight' analogy, so long as an individual's problem can can be 'managed' without insurance by going to an emergency room or their 'premium' is paid for by an employer, value isn't much of a concern. After all, Americans do have the best medical car in the world and nobody's going let anyone die in the gutter. Right?

    So the problem isn't really ethical! Private insurance have never been able to contain the costs of whatever industry it dominates. With no dog in the fight, few of us will work to get the best bang for our buck. Switching private insurance for public by changing to a 'single payer plan' will do little to contain costs, increase value or serve the best interests of us all unless we require and reward successful preventative care. Car companies are on the right track by giving lower premiums to drivers who prove their 'safer' by hooking up a black box to their vehicles.

    Mandatory counselling/treatment for the obese is hinted at in Obamacare, Too many American's seem obsessed with 'freedom', even as it applies to lifestyle that in turn causes illnesses that end up being paid for by the rest of us through our flawed reimbursement system. I don't think it's unpatriotic to act with the best interests of the majority, even if an individual loses his ability to eat ice-cream every night before bed. My fear is America may never learn!
  • Feb 8 2014: It seems only too apparent to me, that for any medical system that is based on profit, it has to be profiteering off of the suffering of people.

    And if you're willing to say, I prepared to profit of the suffering of people, then, just like war, your humanity has to and will always be, if not lost - a lowly second place.

    It matters not how you dress it up with words, such as physician entrepreneurship, as that's a euphemism by any other name.

    The initial question also somewhat presupposes that such organizations an non-profits cant or don't exist. Since they do, one has to ask why can healthcare be non-profit? Why do people believe that everything has to have a profit motive. Why can't the two most important aspects of your life, healthcare and education not be like this.

    If they are, does it not only serve the country and humanity better, as a more educated workforce is obviously where her are headed should we wish to succeed. As well as a healthy one, if only to ensure that people are fit and able to contribute to society, after all it's very hard to contribute effectively when you in need of medical attention.

    One thing should be noted, that is, the current diet and massive obesity problem that exists today is one of our own making, if fact, I would not be surprised if given the average persons diet, that a dietitian could not make a worse one than what is currently consumed.

    It should not be overlooked on the impact that diet has to overall health, and changing that, could well be the retardation of many a cause of what ails most developed countries with respect to healthcare issues. Too often we ask a doctor to prescribe a pill to continue on with the way we currently live, rather that prevent what obesity brings.

    The last paragraphs are not directly related to profit/free/non profit, but it would be remiss not to cover this topic too, as one ounce of prevention is better than one pound of cure. But that's a lesson we just don't what to hear anymore.
  • Feb 8 2014: Personal
  • Feb 8 2014: I have already posted one comment on this topic, but let me make another based on the "maco-organizatioal view" of this ethics question.
    First of all we should discriminate about the patient care and the health care business/industry as an entity. If we look at the old-fashion medical practices, then the physician hires the nurses or health care orderlies, the the physician is the sole administrator of the business, and at least the major decision maker. Then the ethical consideration of this "business" and the medical practice are more or less coincide, and the entrepreneurship has the same responsibility for the medical ethics.
    However, when a hospital (or pharmaceutical or even a clinical laboratories, etc.) is set up, they should no longer be treated or classified as a solo, or group medical practice, they should be treated as a business. So, if a hospital decided to rebuild a lobby or to lay off 100 nurses. the decision is made by the board of directors, then that is not a medical decision at all. Even if the original suggestion is made by the hospital administrator who is an MD, still he acts only as an administrator rather than a physician. You may say that then we should not allow the business of a hospital to exist. But it is not practical, because we set up a hospital to be an assembly of medical staff, allied health personnel, diagnostic equipment, patient rooms and food services, etc. these all needed capital investment, thus it has to be a BUSINESS.
    There are no rules that a business has to abide the ethics of no harm to any particular patient unless it is negligence. This rule actually applies to other business/industry; for example, the food or drugs that harm the consumers, or car makers with malfunctioning cars causing injury or death.
    The ethical question of the medical practitioners should only apply to where a patient is accepted for treatment by the physician. Professional "pro-bono" work should be voluntary, not compulsory.
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    Feb 8 2014: Arlen, are you referencing personal ethics or the ethics of a society?
  • Feb 8 2014: Should we ban for profit healthcare companies ? Should we let private practice die?
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      Feb 9 2014: Arlen,
      Rather than trying to ban and/or get rid of practices, how about if we guide people and practices to be accountable and responsible?
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      Feb 9 2014: Arlen,
      This is a response to your question...
      "Which people.? How would you hold the accountable?"

      All people, and I suggest that we hold ourselves accountable, and be responsible for choices we make regarding health care.
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    Feb 8 2014: No!
    If business in the USA was ethical i.e. not so greedy, profit-making in healthcare would not be such a big problem. However, excessive fortune-making in healthcare is directly or indirectly involved in decision-making about providing care. A shameful state of affairs.

    From NY Times in June, 2013 some Healthcare CEO salaries and holdings in the millions for 2012:

    Richard Bracken, CEO of HCA-34.6 & 84.5 million, Leonard Schleifer, CEO of Regeneron, 30.0 and 666.1 million, Kent Thiry, CEO of DaVita, 26.8 and 66.3 million, David Pyott, CEO of Allergan, 19.4 and 108.0 millio, Miles White, CEO of Abbott, 19.0 and 143.2 million, Ian Reed, CEO of Pfizer, 18.5 and 48.1 million.
    • Feb 8 2014: Beth unfortunately as for a comparison you didn't put what a nurse gets.

      You know the one that's there by your side day in day out, not just a consultants quick hello at 10am and gone at 10:01am.
  • Feb 8 2014: SUMESH

    http://www.politifact.com/oregon/statements/2012/feb/23/alan-bates/does-20-percent-population-really-use-80-health-ca/

    and there is article from Forbes and many others. Most cost incurs in the early life and end stage life. Reform here will go long way,

    If you it you will find lots of these articles including some some disputing it. It is not from my brain.

    Medicine may be clear on point of death but society and politics is not

    RAJ
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    Feb 8 2014: Business ethics work well for products and services that can be bought and sold. That's where it ends. It does not work at all well in healthcare, due to the mismatching of standardised business ethics with the personal morality of end users, and the expectations of businesses to turn a healthy profit at the expense of the unfortunate. Healthcare is not a product, because it is so deeply saturated in structures of personal morality, that no amount of business ethics could ever be expected to be compatible with it.

    If I become ill, I wouldn't want business ethics to push me to one side because of my inability to afford treatment. My health and well-being should not be dependent on what does or does not exist in my bank account.

    The two are incompatible in my opinion.
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      Feb 8 2014: Allan,
      Healthcare these days is very much about products and services that can be bought and sold, and like some other business ventures, it has sometimes also become an opportunity to "turn a healthy profit at the expense of the unfortunate".

      While you say that healthcare "is not a product", there certainly are lots of products sold within the category of healthcare.....drugs....medical supplies, prosthetics, etc. I've even noticed ads recently promoting one brand of "knee" (for knee replacement) over other brands. There is an ad which recalls a certain brand of "knee", and advises the public that if they have this particular knee replacement they should have it removed, even if it isn't a problem for them yet!!! The number of ads for drugs on TV is staggering!

      I understand your point. However, it appears that the "business" of healthcare is very much entwined with the actual practice of healthcare, and I don't see any way to separate them at this time, so it seems that they could co-exist with good ethical practices.

      I agree that people should not be denied treatment because of their bank account. I am grateful that when I sustained a near fatal head/brain injury, there was no paperwork or questions asked before I was rushed into surgery! The only thing they asked my son, who was with me in the ambulance and at the hospital, is my name, so they could put a name bracelet on me, and try to connect with the unconscious person by using name recognition:>)
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        Feb 8 2014: Hi Colleen. It feels like I haven't spoken to you for ages!

        Agree that the likes of Big Pharma are by necessity run entirely on a business footing, but does that automatically equate with ethical practice related to people who are ill, and therefore vulnerable? I have my doubts.

        I understand that pharmaceutical research receives a great deal of impetus from private funding and if it wasn't for that, we wouldn't have the ground-breaking drugs we have now. However there seems to me to be a failure in business ethics 'on the ground' to run parallel with it's own ethical framework, let alone the acute moral standards of people who are very sick.

        Professional ethics in healthcare seem to be more reliably implemented during times of plenty, but during times of economic instability, the ethical gulf between business health and human health would seem to get uncomfortably wide.

        The commodification of illness and the ethics that go with it, are therefore subject just as much to variation as the vagaries of stocks and shares in times of uncertainty.

        It is open to question that just when people are prone to illnesses related to financial stress during recession, business ethics related to healthcare, by nature, would tend to move in the opposite direction. If ethics were related entirely to the human condition, that would be unlikely to be an issue.

        It's heartening to hear your personal experience, that the treatment you received after your injury was able to rise above any conflicting code of ethics from any other sector, other than that related exclusively to your own well-being.

        Thank you for sharing that.
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          Feb 8 2014: It has been awhile Allan, and always a pleasure:>)

          We certainly DO have ground breaking drugs, which in my perception are often overused, because pharma likes to keep a profitable bottom line, and medical professionals are often convinced to use the drugs when there may be an alternative.

          Drug reps came into a doctors office (where I worked) regularly with boxes of samples for the docs to distribute to patients, who were grateful for the samples. Then the doc wrote prescriptions for that drug, which the patient had to buy.

          I agree with you that the commodification of illness and ethics may be subject to variations, and that may sometimes depend on the individuals, the facilities, and practices of the interconnecting healthcare/business as it is managed?

          It is heartening for me too Allan, to know that my experience may have risen above any need by the "business" of healthcare, to come before the preferred treatment. I probably would not be here otherwise:>)

          Several elements of the experience are interesting...
          I was horseback riding near a ski area, and it was ski patrollers who were first on the scene...almost immediately because they HAPPENED to be going from one part of the area to another part by car...they would normally be skiing...not that day.

          They immediately called the ambulance...rescue personnel HAPPENED to be doing a transport close by and responded immediately...it normally might take them about a half hour to get to the site from their base.

          Although it is advised that rescue take patients to the nearest medical facility, they decided that the larger facility, although farther away, was the better choice considering the injury.

          The director of neurosurgery HAPPENED to be on call, and was in the hosp. when the ambulance called in...they were in contact with him and preparing me (cutting off cloths inserting IVs, etc.). On arrival, the surgical team was ready and waiting. It is a teaching hosp. and I guess we all had something to learn:>)
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        Feb 8 2014: To have three consecutive fortunate occurrences after your injury is incredible. You must be feeling very thankful.

        Did you find that the whole experience changed your general outlook on life, and your faith in human nature?

        I wouldn't want to wish such a thing on anybody, but it does generally seem that positivity more often than not, comes from adversity. Especially when help is given unconditionally by others.
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          Feb 8 2014: Yes Allan, I am over, and over, and over again thankful for the care I received. Even as I wrote about it in the comment, I was feeling again, overwhelmed with gratitude.

          Since we are talking about healthcare and business, the cost of my hospital adventure was well over $300,000, and that was 24 years ago...thankfully 100% paid by insurance. The cost of many procedures and treatments, as you well know, is becoming prohibitive for lots of people.

          I cannot honestly say that it "changed" my general outlook on life or faith in human nature. It definitely intensified many things I had already embraced about life and human nature.

          I've mentioned many times here on TED, the lessons I learned from my mom from the time I was a wee little lass....the idea that life is an exploration in which we can learn and grow, and unconditional love as an interconnecting thread:>)

          I wholeheartedly agree Allan that challenges offer an opportunity:>)
  • Feb 7 2014: The business environment is all about competition, its akin to a horse race or a stampede towards individual success, there is no true care of others as we compete to secure our individual well being.
    The 21st century business environment sometimes contradicts with with our natural humanity. Lets go back a century or so...(not a long time in the grand scheme of humanity)

    Its human to live in a community, take care of your family and friends and your neighbors in that community, They will take care of you when you need that care.
    True care and competitive business are not compatible.
    The market distorts the compass of the caring profession. Carers are human, they truly want to care and help. The market drives that care only towards the patients who can deliver a profit. A boob job for a wealthy girl, nice teeth veneers for the economic winners. This profit driven system depletes the necessary care that can be given to people of low wealth. The caring professionals are hindered in allocating care to where it is most beneficial because they are shackled to a profit driven business model.
    The only way to truly maximise health care, ie to deliver the maximum amount of benefit from the resources available - is through a national health service akin to the uk NHS.
    Ideally private medical practice should be discontinued as it pulls care away from patients who need it most towards patients that can pay the most.
    Within the NHS doctors have budgets to spend on their patient base. They spend that budget within the publically paid (Taxes!) health service...The service works like a market with the doctors demands and budgets directing and shaping the supply of medical care. Its not perfect, nothing is. The Uk people are by in large very proud and protective of this service.
  • Feb 7 2014: Yes. We must stop thinking in one totality versus another. There will be doctors who will limit their practice to friends and families of the wealthy and reap all the benefits--assuming they maintain the heights of professionalism. And there will be doctors who don't come from that kind of wealth who will still make more than satisfactory livings treating people in clinics. Once someone tries to turn it into one totality, the backlash will start and I guaranty it will result in more people "getting while the getting is good". The right has been scaring America with talk of socialized medicine for ages, and each time, that's what happens--money grabs that push up the prices for healthcare and medicine. I for on wish the Democrats would see the wisdom of formalizing commitment, law and language to keep this fear-mongering at bay by ensuring that we won't ever be a socialist totality but it is in our best interest to acknowledge and echo that a hybrid system will be our constant.
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    Feb 7 2014: Healthcare/Business are COMBATABLE by definition meaning conflict. Healthcare/Business are not COMPATIBLE in the sense that the two will never coexist without conflict.
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    Feb 6 2014: End Private Healthcare Now!
    I have decided this is a worthy cause upon which to define the purpose of my life.
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    Feb 6 2014: This weekend my sister and her newborn baby were 'killed' by a deficient and greedy private healthcare system.
    As a doctor on the cusp of completing my specialization, I can honestly say that private healthcare is greedy and will not deliver life saving treatment if you cannot pay them the high fees they demand.
    My sister Depika was 33, fit and well with everything to live for and eager to enjoy further life with her husband and baby boy who was due end february.
    She Abrupted, bled, was rushed to hospital, and then waited 2 hours while the private hospital she regularly visited, roused up suboptimal staff to deal with an emergency they had not the skill nor the equipment to handle. Had she gone to the government/state hospital a short distance away, she may have been in a shoddier building with less than polite staff, but she and her baby would have been alive.
    The obstetrician did a terrible job, the anesthetist pandered to the wishes of the inept obstetrician, and there was no pediatrician available at the time to resuscitate my nephew who died after 20 minutes of nurse-led resuscitation.
    My sister was transferred to a poorly equipped private icu with doctors NOT available unless arrangements had been made.
    She was managed sub-optimally (because private healthcare is very poor when it requires medical excellence to be displayed), and she passed away hours later on saturday night.
    We missed my sister's death by minutes and never got to see her last breath, never got to cradle the baby, or understand how it could happen when so much money was available to pay for any type of anything to save her.
    Private Healthcare is a disease! It is a scourge and a stain on the noble art of medicine. There is ZERO place for capitalism in a field that DEMANDS Humane excellence. I long ago opted out of it. It lulls people into a false sense of security and then shows it's true colors when you demand excellence or humanity. The legal processes we now enter will not bring them back.
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      Feb 7 2014: I am very sorry for your loss Sumesh.

      Since you are, or have been in medical school, as your profile says, you probably have more information about this situation than most people. You say you "long ago opted out of it". I am sorry for that too, because as a person who is aware of the challenges, there may be an opportunity for you to contribute to change as a medical professional?

      Again.....very sorry for your loss.
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        Feb 7 2014: Thank you.
        Yes I am active in the contribution to change department. I won't see it in my lifetime, but it will come. The sooner the better.
        The right to breathe clean air and live longer trumped the commercially driven battle to self determination and opting in or out of smoking in public. Looking back it seems impossible to imagine a time not so long ago when you had to seek out clean air and found it easier to do so if you were wealthy.
        So let it be with high quality healthcare.
        I'm somewhat of a socialist when it comes to healthcare.
  • Feb 4 2014: Suggestions:
    Become a better customer
    Recognize that doctors can't take care of you if they don't make some fair profit doing it
    Demand management, miitgation or elimination of conflict of interest from your doctors
    Spend every dollar as if it were yours
    Recognize that employed physicians will cost you more
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      Feb 6 2014: This does not drive excellence and innovation.
      This is civilizing greed not demonizing it.
      When doctors are regarded as scions of humanity globally then we're on the right track.
      Right now, you make doctors look like supermarket managers.
  • Feb 2 2014: I absolutely love this question and topic! My background serves me to have had, and continue, to see the impacts of the ethics of healthcare and the ethics of business! Sadly, as much as I would like to say that I can see the two co-existing, I unfortunately, cannot say that I have seen it yet. Harish Manwani's talk on "Profit's not always the point" was a brief, yet carried a huge message, and one that I hope continues throughout the business world......what is your value and purpose?

    As I could go on and on with my thoughts and ideas toward this question and topic, I will stop here, and say that I believe that if there are enough of us working to achieve a co-existence between healthcare practices and business practices we may just succeed!

    Best to everyone!
    Stacy
  • Jan 29 2014: Hi Bradley

    Business is not regulated; and its base ethic is to gain cheap commodities, and sell them for maximum profit.

    Historically it has been the strategy in regard to achieving this aim; to use the power of profits gained, to politically/criminally overpower competitors; in order to monopolise the commodity, and negate consumer choice (E.g. Diamonds).

    Business’s do profit from the poor, and cause further poverty; by using e.g. cheap minerals gained by e.g. Australian/Multi Corporations, as the basic commodity in “Free Trade Deals” with e.g. China; whereby the business partnerships profit from the Chinese poor/cheap labour + cheap Australian minerals.

    And thus these Corporations and their bought Party Politicians; knowingly destroy their own fellow citizens manufacturing industries, impoverishing them; while seeking to vindicate their unpatriotic and parasitic practices, behind the “Sheep’s Cloak” called Globalisation”.

    All citizens of all countries; should be entitled to health care, education, policing, legal services, emergency services, etc. as a part of a return of the taxes they have paid from their salaries; for having done an honest day’s work, which these Soulless Corporations, and their equally soulless and bought Party Politicians and Corporate Shysters' are incapable of.

    In sum.

    As the impoverishment of people, and environmental destruction in Third World Countries underlines; the ethics of Corporate Big Brother and the Humanities, lie at Polar Extremes.

    And sadly; the ethics/materialism pertaining to the overall networking structures of Big Brother, are in ascendancy; and involved in the ever increasing, and compounding industrial processes; that are used to war, against the “indomitable powers” of Nature (E.g. climate changes); which sooner rather than later,
    will cause unprecedented levels of starvation, anarchy, devastation; and ? the extinction of humanity, inclusive of the disciples and the progeny of Corporate Big Brother.

    Carl
  • Jan 28 2014: Business is regulated when the consumer has a choice. Business does not profit from serving the poor. I would suggest a national single-payer healthcare system that provides free basic care to all. Doctors in this system would not to subject to malpractice suits and such. Businesses can then offer higher level services for prices that compete with other high level providers. Doctors can choose to operate as high level provider specialists or operate within the basic system. In this way healthcare and business ethics could be made to coicide, while providing basic care to all. Doctor candidates could receive a free education in exchange for an extended recidency period in the basic system.
  • Jan 28 2014: RE: 3 days ago; Arien Meyers MD. MBA.

    Quote: The high cost of drugs and what are "excessive profits" is certainly an important topic. When it comes to rewarding innovation and entrepreneurship, though, where do we draw the line? Does even drawing the line threaten the innovation pipeline? Should a 10,000 a month drug even be on the market if it extends survival by 2 months?
    ..........
    Hi Arien

    The high cost of drugs is a single factor in regard to the enormous and IMO, fraudulent profits; that medical related manufacturers, and retailers are making in all areas of medicine.

    One only has to refer to an anaesthetic and medical equipment brochure, and look up e.g. Operating Room chairs, and an “identical chair” to that which can be purchased for e.g. in a furniture chain store for $100, will cost four or more times as much; simply because it has been re-labelled and catalogued, as being medical equipment.

    And these medical companies are aware that they can, and they do charge what they can get away with; because they are a closed market, and their supplies are lifesaving and essential to the medical professions.

    As to where the line is drawn; that is not a question for either the medical professions or the general public, to be called upon to answer, for it is impossible for them/us to do so, or do anything about it.

    This is what we pay our so called public servants, and “supposedly democratically elected” Right Honourable “Party Agenda” Politicians to do; but instead they allow businesses and retailers to charge whatever they like; while supporting them in keeping the professions and worker’s salaries as low as possible; and while aiding and abetting them, in acquiring/privatising the “common-wealth of the people” (A nations natural resources) and tax payer funded public utilities (The people’s property).

    As to whether a $10, 000 a month drug that only extends life for 2 months, should be placed on the market IMO no it should not.

    Ref; to post 15 hours ago
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    Jan 25 2014: Healthcare and education are, arguably, two of the most difficult problems facing the US.

    George Halvorson, who is retiring next year as CEO of Kaiser Permanente, mentioned in one TV interview that Kaiser Permanente members pay 20% more on their insurance premiums because they are subsidizing those who do not have health insurance but who are getting treatment and care at Kaiser Hospitals. And this situation is not unique at Kaiser. This is the situation in every hospital and medical clinic all over the US.

    Remember Million-Dollar Murray? So does Washoe County, Nevada.
    http://gladwell.com/million-dollar-murray/

    The other issue is that many healthcare vendors and providers, hospitals and pharmaceutical companies, are charging excessive fees that drive healthcare costs through the roof. Many concerned leaders who are in the know have been saying for years that there will come a time when we, both as individuals and companies, cannot afford healthcare anymore and it will bankrupt us all.

    The Affordable Care Act is supposed to deal with this and the other complicated issues, but it's doubtful whether it will succeed. There are just so many conflicting interests.

    We, humans, always want the best. But some of us, want the best for free. "There is no such thing as a free lunch". If one does not pay for something, someone or some other people are going to pay for that something - whether it is a bridge, a school, a hospital, a surgery, or a medication.
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    Jan 24 2014: If the core value of healthcare is profit maximization, yes, then it is compatible.
    • Jan 27 2014: The foundation stone of recognized and organized treatment/healthcare, began with the Greek physician/doctor Hyppocrates, and hence later came the Hippocratic oath, and the fundamental ethics as outlined by Danger Lampost.

      Therefore it follows; that the core values of medicine/healthcare was not and should not be for profit or profit maximization; the profit based, and profit maximization policies of health care organizations; is about greedy, cold blooded, corporate, and money and share market parasites, feeding off the ill fortune, and aggravating (To the point of causing an enormous number of deaths, to those who could otherwise been saved) the misfortune of others, in order to line their pockets with (free unworked for) blood money.

      And all words, all excuses, and all arguments, cannot alter the fact that these blood money profiteers, are parasitic miscreants; that is the condition of their characters, and it is with that condition of character, they will eventually go to meet their maker.
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        Lejan .

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        Jan 27 2014: '... the core values of medicine/healthcare was not and should not be for profit or profit maximization ...'

        100% resonance with my opinion!
  • Jan 24 2014: The high cost of drugs and what are "excessive profits" is certainly an important topic. When it comes to rewarding innovation and entrepreneurship, though, where do we draw the line? Does even drawing the line threaten the innovation pipeline? Should a 10,000 a month drug even be on the market if it extends survival by 2 months?
  • Jan 24 2014: No, physician entrepreneurship is not a contradiction in terms because regardless of how much a physician wants to charge, limitations will be placed on that amount by an insurance company. Drug company entrepreneurship is another story. Of course the argument is that no drug company would do research, yada, yada, if they couldn't make money. For some reason, they are entitled to make more than everyone else. I understand that, but as a cancer patient, I cannot for the life of me understand how it is ok to charge over $10,000 per month for one drug. Capitalism is one thing, but once that price filters through the system entirely, who ends up paying for it? -- the other insureds in the form of increased premiums. It's a slippery slope, but people shouldn't be penalized for getting sick.
  • Jan 24 2014: Thanks for your comments. We seem to be having several conversations at once.
    1. Are the business of medicine and art of medicine reconcilable?
    2. Has the medical social compact been broken?
    3. Should patient- customers take more personal responsibility for their health and how?
    4. How does the US healthcare system compare to other global healthcare systems?
    5. How do we stimulate and reward innovation in bioscience and healthcare?

    All of these are, in some ways, interlinked.
    • Jan 28 2014: Hi Arien

      1. Are the business of medicine and art of medicine reconcilable?

      Yes if our politicians were independently “selected & elected by the people” to represent their communities and public interests; rather than Party Politics & Big Business, and held to account by the people = the nation’s shareholders. And thus ensure that excessive profiteering was a thing of the past; and the people received a fair deal for their tax dollar.

      2. Has the medical social compact been broken? Please refer to my previous post

      3. Should patient- customers take more personal responsibility for their health and how?

      Yes = many ways/answers, e.g. research into and relating to maintaining a healthy life style; internet research re illnesses, treatments, drugs, complaint procedures, etc.

      4. How does the US healthcare system compare to other global healthcare systems?

      It stinks! It is totally mercenary, non-humanitarian, and solely corporate profit orientated. As opposed to e.g. the British National Health System “whereby it and all Emergency Services”; are funded by/“returned” from taxes.

      5. How do we stimulate and reward innovation in bioscience and healthcare?

      By ensuring that the individuals and teams involved in these efforts, are both recognised and adequately rewarded for their efforts; rather than Big Brother companies taking all the credit, and 99.9% of the profits.
  • Jan 24 2014: Do you believe that most doctors do what's in the best interests of their patients? Do you trust them?
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      Jan 25 2014: Did you mean to ask this similar but different question?

      "Do you believe that most doctors *try to* do what's in the best interests of their patients?"

      If that's what you meant to ask, then I would say yes. But to answer your original question as you phrased it, I'd have to say "no".
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    Jan 24 2014: I don't think they are compatible.
    In order for something such as 'healthcare' to exist one should clearly understand what exactly is health. What medicine and related technology provide today is 'disease care'.
    Moreover business ethics is all good as long as honest innovation presents something to meet demand. It becomes questionable when business seeks to create demand to make profit. When lifestyle gets included as disease fast food producers are business partners of so called healthcare professionals.
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    Jan 23 2014: OK, the question still makes no sense to me but if you are getting what you need out of it, the problem is mine. So the question is 'how do we create value and reward people that fix you when you are broken?' How do we create value for the physicists that discover the principles to make an MRI. We didn't, the value is understanding the world. We like doing it.The reward is the discovery. How do we create value for the soldier on the fields? The medics get nothing special, at all, and they perform very well. Apparently the reward is saving lives. They don't get payed very much. Money has absolutely nothing to do with it.

    The whole world has health system pretty well solved, it is just the US that can't seem to figure it out. The health distribution system in the US has been the most free of regulation and the most open to entrepeneurship in the entire world and it has been a dismal failure. The profit motive seems to be what killed it. That is why I put up the questions that I did. The profit motive cannot produce a flat distribution of health care, it is theoretically not possible.

    In France the cost is less, outcomes better, distribution is flat, the docs drive BMWs and the people love the system, . In the States the cost is 25% more, outcomes lower, distribution is awful, docs own airplanes and the people hate the distribution system. I don think the problem is creating value and reward systems. The data is in on that one already.

    Thanks for the response I appreciate the time.
    Michael Gerety
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    Jan 22 2014: Aren't the underlying principles the same whether it's medicine, business, or second hand smoke.

    just focus the appropriate values and principles depending on the situation.
  • Jan 22 2014: Ethics is about doing the right thing, particurly when it's hard.
    The precepts of each profession vary. A soldier's ethics is different than a doctor's.
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      Jan 22 2014: Ethics is the language we use to discuss values. Sometimes those values oppose each other. Such as beneficence and autonomy in public health vaccination programs or in healthcare coverage.
  • Jan 22 2014: Unfortunately the question has already been answered by the pharmaceutical industry.
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    Jan 21 2014: Most healthcare systems in the world seem to be overwhelmed by the sheer number of patients and their expectations of what is achievable, in relation to the medical resources available. This (at least in part) contributes to and highlights the conflict between the primary duty to patient-care, and sufficient profitability to continue providing that care.

    Assume people actually start taking more responsibility for their own health, and patient-demand drops by 50% (not unreasonable given how many people abuse their minds and bodies and then expect doctors to sort it out for them later on in life). Would you then think that "physician entrepreneurship" could possibly be a contradiction in terms? (ie: do you think your question at root is mainly driven by current overwhelm, or does it remain a fundamentally generic issue?).
    • Jan 21 2014: Creating value and rewarding it is always an issue
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        Jan 22 2014: ... in which case business and healthcare ethics are compatible. The triple bottom line (people, profits, planet) are just as hard for business as for healthcare, hence physician entrepreneurship is not a contradiction; it's vital.
        • Jan 22 2014: My point, exactly.
          The challenge is to instill an entrepreneurial mindset in every healthcare worke and student and move the doers to entrepreneurs to innovators. Our healthcare system is in such disarray (however it's funded) that innovation is the main thing that will get us out of the mess.
          How would you suggest we do that?
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        Jan 24 2014: My main take on this is first to reduce the pressure on the medical system. A health insurance system with significant "no-claims discounts" as an incentive for people to take at least some responsibility for their own health seems to work well (in Germany and Switzerland). People have to have some sense of "ownership" of their own health.
        As for how to catalyze innovation in a huge medical system with multiple vested interests (some contradictory), I am not sure. Personally I have not seen a doctor in over 25 years and so have little experience of "the system" (U.K), and none in USA.
        For me, the essential problem is the continuing promotion of the idea (coming from the global paradigm of materialistic science) that a human body is just a machine to be fixed by the medical profession. This has value if you have a smashed-up body from an accident, but not if you have a degenerative disease developed over many years.
  • Jan 21 2014: They are almost completely incompatible. A business has one single aim, that is: to make money and nothing else. This has nothing to do with compassion or caring for other people it is a totally selfish activity compared to the unselfish kind of activity that real caring requires. For this reason a business will find all manner of ways to make health care cheap for themselves but expensive for their customers. This could easily include selling poor quality medicines, not taking care in medicinal practises etc etc. In other words a business does not care about caring for people unless they have to due either to a law or because it has no choice.
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    Jan 20 2014: Having further considered this question, business ethics regardless of service or product including healthcare are business ethics. i see no compatibility issues here and I believe none should be inferred.
    Profits are a result of doing business. Without profits, business would cease to exist. I also agree with Mr. Manwani, a business should be more then just about profits, good businesses have soul.
    • Jan 20 2014: Both business and medicine have a code of ethics. For medicine, the ethical code (whether it's followed or not), dictates that the interest of the patient supercede profits. That's why most doctors at some time in their careers, treat patients for free.

      Business ethics are about how to make a profit "the right way". Recent triple bottom line ethical tenants include people and the planet as interests that need to be observed. Making profits trashing the planet does not cut it any more. Reaping profits exploining garment industry workers in Srk Lanka gets headlines now.

      So the conundrum I present for your consideration is about how doctors generate a profit, putting the interests of the patient first, even if it means, inevitably, sacraficing profit or losing money (certainly not in every instance, like cash pay specialties like plastic surgery or others) every time they see another patient.
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        Jan 22 2014: Make preventive care profitable for both patients and doctors.
        Instead of the current illness = profit model.
        • Jan 22 2014: Do you think most patients are willing and able to do what is necessary to prevent illness?
          What would it take?
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        Jan 22 2014: Better question would be are physicians willing to devote the time and energy needed to facilitate patient change into a preventive model?
        That's what it would take.
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        Jan 22 2014: Back pedal, back pedal.
        Much easier to blame patients, payers, government, system.......
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        Jan 22 2014: It seems you are caught in the ethical abyss of cognitive dissonance. People need to take responsibility for what they contribute to the paradox of sick=money and stop assigning blame.
        I'm mot blaming doctors for anything except perpetuating the status quo. You want to have a different status quo. Make it happen. Stop blaming everyone and take some responsibility for change.
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    Jan 20 2014: "Healthcare providers need to be profitable to serve patients." I quite disagree. Why did you start this as the presumption for the conversation? OK, assuming what you say is correct, for the sake of the discussion, yes, by definition. I have a problem with the usage of the word 'ethics'. It is a technical problem with comparing two different systems of rules. They may or may not be compatible depending on the moral constructs and we have lots and lots of different moral constructs in the States so, technically I don't see how one could come up with a meaning full answer. I am not trying to be a jerk. Maybe I did not understand the question. It is your question but I would like to rephrase it.

    Under what conditions is a stable society possible where the health care system is based on the profit motive? Or With our current society is it possible to have an equitable distribution of health care when the health care system is driven by the profit motive?
    • Jan 20 2014: Thanks for the comment.
      THere are those reading this who favor a single payer system with universal coverage. Every doctor would get paid a negotiated amount for being part of the system.

      There are others who favor a private payer system with universal coverage. And then again, there are those who don't believe that universal coverage is a right.

      There are very few single payer systems that don't have a shadow private system.
      Regardless of whether you are a private practitioner, an employed physician (working for the government , like the VA or not), a technopreneur, a social entrepreneur or a consultant, physician entrepreneurs all have a common goal: to create patient defined value.

      We can get really side tracked about how to finance health care. I posted the question the way I did because, in my view, the key issue is how to create value and reward those who do.
  • Jan 20 2014: Yes.
    The ethics of business include "provide a quality product at a reasonable price that permits reasonable profit."

    The problem is that a large number of businessmen are outright lying douchebags when they claim "ethics" of any sort. They operate under "gouge the customer to extract as much money while providing the cheapest crap you can get away with." Their principle of operation is entirely unethical, but they claim they are following "ethics". They simply redefine "ethics" to mean whatever is convenient for them.

    Of course, if you're a cultural relativist or other type of "progressive", my argument will mean nothing, since progressives tend to reject the idea of constant, immutable moral and ethical standards to which all people ought adhere.
    • Jan 20 2014: Physician entrepreneurship is about reconcilling the art of medicine with the business of medicine. Whether a doctor or business person or both, if you violate the trust of your customer or patient, you eventually suffer the consequences. Some don't violate that trust, some do it overtly and some do it covertly.
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        Jan 20 2014: Dr. Meyers,
        I see you have both medicine and business in your little black bag. I for one am highly concerned about my future medical treatments... I am in my golden years so, it's all breaking down.
        My primary care doc called me about a year ago and told me that he was closing his private practice. I asked and he said he couldn't make a living anymore. Then my cardiologist closed his office and ended half his practice to devote more time doing surgeries. His former clerk told me he ended taking medicare. It was recommended to me to join a large medical service group that had medical offices in strip malls all over town.
        I did and went to see my new PC physician, an MD. It was fine and I made a followup in six months.. two months later, I got a letter from her saying she was leaving the practice and I would get a new doctor. I did and he was a DO and seemed nice enough and I made the 6 month follow up. Well, I got a letter and my second doctor left, but not to worry, a new doctor would be assigned. Well, I made the appointment. He was a PA, he was OK, but a little full of himself. I made the followup appointment. I am not worried. I am sure that he will be gone and my next appointment will be with a candy stripper..
        • Jan 20 2014: Your experiences and concerns are well founded given the changes that are upon us.
          1. private practices are dropping at the rate of 2% a year and represent at 45-50%
          2. More and more docs are becoming employed physicians, particularly cardiologists, for any number of reasons.
          3. Obamacare will make access difficult, despite the increase in Medicaid recipients (lots going to ERs still even with insurance)
          4. Look for more NPPs (non-physician providers), part timers (particularly women and older men) telemedicine, PCP shortage,and foreign medical grads to fill the gap
          5. Look for more private practitioners calling it quits

          All the more reason for docs to learn the business of medicine and for medical schools to teach it.
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      Jan 20 2014: Bryan,
      " a large number of businessmen are outright lying douchebags"... that many? I am sure there more then one, but a large number? Is that 100 or 1000? What belies your comment is that customers seem to accept the price gouging and use the cheap crap. Worse, when the cheap crap is gone, they go out and buy more. No accounting for stupid.
      I am not one of those that who will think your arguments mean nothing. They do mean something to me. It's just that I am not sure you would understand just what it does mean.... but that is me and what do I know..
      • Jan 20 2014: Yes, there is no accounting for stupid or doesn't know any better.
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      Jan 20 2014: Yep, I do indeed reject a constant immutable moral and ethical standard to which you tell me I 'ought' adhere. I am not convinced that anyone or group is wise enough to know how people 'ought' to behave; there are two many twists and subtleties and grey areas. Maybe you can maneuver all the complexities, but I can't. Yep, some people lie and cheat, what do you want to do with them? How can you tell who they are? They form part of the system too.
  • Jan 20 2014: Cost accounting in medicine is a mess. Assume you know the cost for an episode of care. How should it then be priced? Cost plus ? Market based ? Value based?
  • Jan 20 2014: they should, but business is too involved with the immediacy of cash to benefit from it. thee was a study done in australia a few years back, which found that every $1 spent on health care saved paid $3 back over time. sound ridiculous until you think about it: a sick person can't work so they can't pay taxes, need welfare, and aren't earning a disposable income so aren't spending and creating sales elsewhere. if you spend money on getting people well now, you have less money right now (which turns away minds only interested in immediate gains or losses), but you gain a taxpayer, higher domestic sales, and a lower welfare expense.

    also business in america currently does not put patients before profit. insurers frequently refuse to pay for treatment for their clients on the basis that it's too expensive.
  • Jan 20 2014: The Hippocratic Oath and the pursuit of profit within the bounds of laws are compatible. Not sure of any other ethics in business.

    Doctors are held to an ethical standard above that of a businessman due to the fact that a person literally places his life in the hands of medical professionals, instead of money. In keeping with the oath, doctors are expected to practice medicine honestly, do no harm, and act as a health agent for the patient. There is a level of trust between doctor an patient that makes patients very vulnerable to unscrupulous medical behavior. This vulnerability needs to be protected from exploitation by laws and medical review boards. This relationship needs to be protected.

    From the business perspective, doctors face a very high risk/reward system. The cost of medical school, malpractice insurance, and the administrative costs of having a staff and running an office are very high. To make the investment of money and time worth the risk, the rewards should enable profit making.

    There are some of odd things in the medical industry that muddy the waters. Doctors are sort of obligated to provide services to preserve life, even if the patient can't pay...other industries do not have this obligation. The government should help in these instances. The number of doctors is controlled by medical school seats and other controls, so it is not exactly free enterprise. The legal risk of a lawyer being able to convince a jury a mistake has been made is very high, consequently doctors must protect themselves with malpractice insurance. Health insurance companies are interested in making profits so they want to minimize care costs and reduce what they consider unnecessary expenses. When this occurs, they are taking the care decisions away from the doctors in the name of profits. Hence, a lot of the problems are based on greed.

    More regulation is needed to control of malpractice insurance, health insurance, drug companies, and legal practices.-Cut greed.
    • Jan 20 2014: Is the Hippocratic oath still relevant given the environment ?
      • Jan 20 2014: Personal question for each physician..I trust my doctor, believing he honors the intent.

        Modern version:

        I swear to fulfill, to the best of my ability and judgment, this covenant:

        I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

        I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of over treatment and therapeutic nihilism.

        I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

        I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

        I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

        I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

        I will prevent disease whenever I can, for prevention is preferable to cure.

        I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

        If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

        Louis Lasagna, 1964
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    JB E

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    Jan 19 2014: Business has no place in healthcare imo because the motives of business in modern age is to get the consumer over the barrel and extract as much money out of them as the market can bear, milk the cow for all its worth with out slaughtering it. Even if the individual physicians don't hold this philosophy everyone else involved does to some extent, the insurance companies, drug manufacturers and so on. In the US you can see this because the capitalism has run away out of control. The reality of the situation is that the government should be responsible for the health of its citizens as the country's productivity and prosperity are tied to its health. I propose this argument works with education and transportation as well.

    Sadly I believe that the changes necessary to fix the US healthcare situation and medical industry are not going to come in my lifetime and probably not even my kids lifetime as the people in this country are so afraid of centralized anything as if we are still paranoid of communism like during the beginning of the cold war. Perhaps we just need to wait for all those cold war era people to die off before younger progressive thinking people can take their places in power.
  • Jan 19 2014: Generally speaking, No, ethics of healthcare and business not compatible..
    My opinions/experiences come from working 17-yrs. in the trenches as a medical social worker (master's-level), currently in a regulatory/investigatory capacity. Pre-MSW experience in social justice/change.

    The U.S. system of health care is broken; no news there.

    ** Physician entrepreneurship should exist as separately as possible from physician care of patients.
    I endorse Universal Healthcare as described by previous poster Jimmy Strobl.

    Given: Physicians and patients are humans.
    Humans do not fit well or uniformly into the machine of our health care system. Mechanistic answers do not succeed in health, and many other, disciplines that involve humans. MUCH pain, inefficiency, squandered money, suffering and danger (life/death) result from the mistaken idea/belief that humans are widgets.
    Human nature will always trump attempts to mechanize health care disciplines/industries in which humans are the intended widgets.

    ** Fair is a place where you get cotton candy. Greed/money dominates all transactions on our planet, with the possible exception of some indigenous societies. Greed/money dominates all systems of health care, including universal or European systems.

    ** Price transparency in health care would help the U.S. a lot. How to get this past health insurers is the sticking point, for now.

    ** Specialist income disparity - between specialties? within same specialty? Sadly, some people's work will always be perceived to be more valuable than others'. Universal health care would even out the peaks/valleys of income between/within specialties. In effect imposing income limits with in universal health care system.

    I am inexpert in my ability to present my beliefs well. I believe, our world would do well to construct systems that, at conception, go with not against human nature. There are thousands of regular people working in health care that know this in their guts.

    For Sale: Magic Wand
  • Jan 19 2014: Several issues:
    Specialist income disparity
    Lack of price transparency
    Fairness
    Income limits ?
    • Jan 20 2014: The crucial point about the specialist-general practitioner compensation is due to the peculiar rules that when the hospital charge the total cost of the care, they usually exclude the charges by the specialist and let them bill the patient directly, even though the patient has no say which specialist they like to be serviced. The latter charges probably are determined partially by the manpower shortage of the specialist.
      As far as the "charity" service to the no-pay patients, as I said that, A. Sometimes, even a non-medical person would come to the rescue of a patient with sudden illness attack or injury on the street, so that if a physician happens to be there whether he come to help is voluntary and based on human compassion, not necessarily a duty. B. The emergency facility of a hospital serves the "charity" function, but the physicians there would be paid by the hospital, probably with a slightly low rate.
      Also, IMO, the profit motive is not unjustified, as long as that you don't operate as a monopoly and compete with better price and/or service. Then the problem of fairness or transparency does not exist as long as there is no government imposition of some peculiar or illogical rules/regulations.
  • Jan 19 2014: Thank you for the tip
  • Jan 19 2014: That's what makes someone ethical or not. Can health professionals make a profit while maintaining the primary interests of the patient even when the patient is unable or unwilling to pay?
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      Jan 19 2014: Arlen, if you want people to see your response to their posts, use the reply link off to the right of their names. Then they will be notified in email that you have replied to them and can follow the link to see what the reply was.

      If you post simply to the top of your thread, only you are notified of your post and those who may read do not know to whom you are responding.

      Separately, here is an article from today's New York Times that may be on point of your question, as it includes some discussion of the course physician entrepreneurship may take. http://www.nytimes.com/2014/01/19/health/patients-costs-skyrocket-specialists-incomes-soar.html?hp
  • Jan 19 2014: There are four elements to physician entrepreneurship:
    Pursuit of opportunity
    Deploying innovation
    Creating patient defined value
    Using scarce resources

    Don't confuse how care is delivered with how care is financed
  • Jan 19 2014: The question involves 2 aspects about the services of a physician.
    The first aspect concerned with the physician's service as a professional. Then the just compensation should be within a reasonable range similar to many other professionals such as the lawyers, architects, plumbers, electricians, etc. There shouldn't be any argument about the justification about it. And, in my opinion, the compensation should be relatively high because of the "value" of such service and the amount of training to be a physician is also higher than other service professionals.
    The second aspect is the organization of physicians' service group, either as a private clinic or a hospital, then also it could be a health maintenance organization or a health insurance group. The initial motive is actually to save the cost of service because of the sharing of medical equipments as well as the auxiliary personnel within the group. But, regardless of the nature of the organization, the so-called profit is originally based of free market competition, so that the better organized and operated ones get the highest profit. This is actually no different than the competition in any business or manufacturers, also included are the banks (with asset management divisions), lawyer groups and architecture firms. You can treat them as a group practice of professionals. As long as there are free competitions, there shouldn't be criticism about it.
    There is also the ethical consideration, i. e., a physician usualy sees a patient who could afford to pay for his service. But that should be a voluntary action by an individual physician. Usually it's done for most of the uninsured with eather a hospital or a private physician. The government involvement is really making matters worse because they just added a layer of additional cost onto the professional fees for such services.The single payer system is just like the military draft or voluntary system. This should be based on democratic voting choice.
  • Jan 19 2014: Generally I would agree with you but america has become deeply engrained .in capitalism and people who run these company's sometimes have to give up a portion of their humanity ( ie the decisions that most of us would consider sensable) for the good of their employees and busness
  • Jan 18 2014: The pursuit of opportunity to create value
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    Jan 18 2014: all i can say it is both compatible and incompatible. But, It all depends on the 'cocnsience' and the 'Hippocratean oath' of the Physician, health care providers.
  • Jan 18 2014: We have more in common than you think
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    Jan 18 2014: They are perfectly compatible Unless government gets involved.
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    Jan 18 2014: What do you mean by physician entrepreneurship, and what do you mean by private practitioners? For example, are the doctors in HMOs what you would call private? Or the doctors at a hospital attached to a public university?

    Most people want their doctors to be expert in diagnosis and to know which avenues are most fruitful to pursue in terms of tests and treatment, to monitor their progress noticing key cues as to whether things are going right or wrong, and to make effective corrections when things do not progress as hoped. Most want the doctor to answer their questions and listen to their descriptions of symptoms.

    Where is the entrepreneurship in this picture? If you mean entrepreneurship in the sense of tailoring care to the situation at hand, I see that.

    But there are many things people may admire and yet not value in a doctor. For example, I admire a ballerina at her art but I would not care about the doctor's ability as a dancer.
  • Jan 18 2014: A nations healthcare system relects it's values. We value independence, are suspicious of centralized government and admire entrepreneurship. In addition, patients in the US value private practitioners
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      Jan 18 2014: Yeah, and your values are damaging for general health care... Values can and should change in accordance with what works, they shouldn't be kept for the sake of keeping values.

      But you and I aren't going to get anywhere are we? I thought from the question that you were open to alternatives to your system but it seems you aren't...
  • Jan 18 2014: Thanks for educating us. If you believe the profit motive has no place in medicine , what advice would you give to private practitioners who lose money every time they see a Medicaid patient?
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      Jan 18 2014: I didn't mean to be condescending, it's just that I've found that most Americans are unaware of the concept of Universal health care and how it works. And how good it works and that the US is among very few modern countries that don't have it, and your health care is among the worst in the developed world.

      There are ways around private practitioners issues that mean that they can still profit from Universal health care, however I don't think that it's a good solution. What they would do is bill the government/state.

      It works pretty well here in Sweden but it's gotten worse since we had the invasion of private practitioners.

      Could you give me a reason why private practitioners should be allowed at all?
  • Jan 17 2014: The ethics of medicine place the interests of the patient first. However, particularly for the rising numbers of employed physicians, there are conflicts of interest, with the employer's, industry, personal and societal interests vying for attention.

    In addition, physicians are being squeezed by increasing costs, regulations and overhead and decreasing reimbursement as the system shifts from a fee for service model to a pay for value model using bundled payments.

    No margin, no mission. Which is it? Patients or profits and how should we reconcile the two?