As you know, I am an advocate for the philosophy that ‘everybody lives by selling something’ and that people buy from people they trust. At its best, selling is about the principle of exchange:- the exchange of value where both parties benefit from open and transparent communication and know what they are engaging in.
So can ‘selling’ be seen as a legitimate role in the various practices of medicine? I.e. GP’s, dentists, optometrists, physiotherapists, surgeons, etc.
If we take it that good selling is where people are fully informed of the facts surrounding their situation, are given legitimate options to choose from, and are in a position to make their own decisions without fear of deception, bullying or intimidation then, yes, selling can form a part of the practice of medicine.
Educating your ‘clients’ is a key function of good selling and selling does involve persuasion on occasion, especially where people are concerned about the decisions they have to make as it relates to their priorities, needs, wants, fears, desires or frustrations. Some clients are prepared to take more risks than others. Any good sales person or medical practitioner would make sure their clients are made fully aware of the risks so they can enter into a decision with their eyes open. Offering your best expert advice is part of what we pay the medical profession for.
Bad medicine like bad selling is about tricking people and taking advantage of the unsuspecting and the uneducated. And as the medical profession is part of the educated elite, where there is knowledge there is power.
My concern lies in the corporatising and commercialisation of medicine and I feel it is posing some ethical problems by creating a range of competing motivations such as ‘Do I do the best for my patient or my shareholders’ wallets?’
You may notice the increase in the amalgamation of medical practices, especially in the areas of dentistry and optometry and the shift in focus to shareholder value. It’s similar in my view to corportatising child care and look at what happened there.
A couple of years ago, I was asked to present information on ‘selling’ to a dental group. They were interested in how to bring a sales culture into their business and get patients to buy more, especially ‘teeth whitening’ and other ‘vanity’ offerings. I must say, I felt very uneasy and did not continue with that business. A recent article in The Weekend Australian, 28-29 August 2010 titled ‘Ethical doubts over optical sales’, highlighted the potential issues with the ‘corporatisation’ of Optometrists. The President of the Australian Medical Association highlighted the possible ethical dilemma and conflict of interest, with optometrists working for large corporates and their emphasis on selling prescription glasses. Whilst he stated that there was no evidence of the over prescribing of prescription glasses, he raised issues about providing accurate medical advice and the desire to increase the value of the ‘sale’ and shareholder value as a real risk. The issue revolved around ‘trust’ – trust in the advice given and the options presented.
This is not just hearsay. Take the following scenarios I came across in the last 4 weeks:
- A dentist, about to clean the teeth of his patient after the normal check up, suggested that the patient should have a photograph taken of their teeth so they can have a before and after shot. The patient agreed, but found out later when they got their bill that they have been charged $55 for the photograph unaware they were required to pay for it. At no time did the dentist inform the patient that there was a cost associated with the photograph. When the patient confronted the receptionist about her bill it was immediately refunded without question.
- A patient is overcharged via her private health fund by her dentist. The dentist was able to access her private insurance surplus taking advantage of her savings. When she confronted him he told her ‘bad luck it’s already done’. Now she has to take her complaint to the Dental Board and her insurance company wasting her time and creating more angst.
- An optometrist offered to take a photograph of a patient’s retinas to check for pressure build up, etc, and like the dentist above, didn’t inform the patient that there was a cost associated with this. Later, the patient found out there was a $90 fee attached to the photos, and upon challenging the receptionist, had the fee waived.
That optometrist patient was me in this instance and as a result I no longer go to this optometrist. My trust has been breached and I could not rely on his opinion or advice any more.
I understand that dentists, optometrists, vets, naturopaths, physiotherapists and podiatrists, for instance, have ‘retail’ arms to their businesses because they can sell ancillary products. However, I am proposing that there needs to be more attention paid to the transparent selling and ‘up selling’ of products and services between the medical advice given and the sale of retail products. Not having met all medical professionals I can only assume that the vast majority know the difference between giving sound medical advice free from bias and the offerings in their retail business. For instance, I like going to my vet. He gives me good advice, and he hasn’t tried to take advantage of me by over selling products or offering me things I do not need. He informs me of my choices and, as a result, I reward him by returning to him when I need vet advice as well as buying my dog and cat food from him rather than the big pet store a few kilometres away. I like supporting him and I understand that retail is part of his business mix. I buy from him because he is a good vet and he also offers products of a superior value that I couldn’t get at the supermarket.
The spotlight, too, is being shone more brightly on the relationship between the medical profession (GP’s and Specialists) and the pharmaceutical and pathology industries. I wonder how many have been influenced or even induced by pharmaceutical or pathology companies to change their prescribing or referral habits in favour of personal benefits at the expense of patients. No wonder people are increasingly feeling cynical and wary about the intentions of the medical profession.
In conclusion, I recognise the need for businesses to be well run and profitable, however, when shareholder value outweighs the health and wellbeing (financial as well as physical) of its clients or patients, then I think we need to question the application of ‘selling at all costs’ in these cultures.
Remember everybody lives by selling something.
Author: Sue Barrett, www.barrett.com.au
Dear Sue,
Of course it is true that in all professions people are required to make a profit to sustain their services. Hopefully this can be done by charging a legitimate fee for the services rendered. In the case of optometry, most patients are bulk billed and the income generated from consultations is insufficient to cover the costs of the latest diagnostic tools, that without doubt, enhance the quality of care offered to the patient. Retinal changes are often more easily visualised, documented and communicated with the use of photography. Typically retinal cameras cost in excess of $30000 and they are not part of the prescribed testing covered by medicare. Although there is a valid argument about informed consent to perform testing (cost etc.), I am concerned that your article implies the optometrist is charging for unnecessary testing. It is foolish to leave an optometrist because they charge for retinal photography, in all likelihood they are enthusiastic about their profession and have invested in technology that allows them to care for their patient base (i.e. you) appropriately. You will always find a cheaper, or ‘free’ eye test but how do you as a consumer judge the quality of that test, and what price are you willing to associate with the highest level of care for your vision. As an aside, I work for a large corporate optometry chain, I am under no pressure or sales incentive commission etc. to upsell, and I prescribe glasses only when clinically appropriate. As commented in the original article “there was no evidence of the over prescribing of prescription glasses” – what then motivates the author of the article you refer to?
Hello there Concerned Optom
Thank you for your comments with respect to my article ‘can medicine and sales mix?’ I will post your comments on the website when I return to Melbourne as I am presently interstate. I agree with you with respect to providing the best medical advice and service possible and the investment in the right equipment. My issue is with the lack of self disclosure and not being informed prior to purchase. I would have likely paid for the retinal photos had I know the cost up front and was able to make a choice but in this instance I was left uniformed and that is my issue. I have medical sciences degree, am an active sportsperson and parent so am all for preventative medicine, healthy life style, etc. I am not for unnecessary medical procedures. I see retinal photos as preventive.
With respect to what motivates people to write such an article as was posted in The Weekend Australian I cannot comment on the writer however the 4 Corners program last night about the commercialisation and patenting of genes highlighted how a number of organisations have put the dollar before the wellbeing of patients and forcing people to seek gene testing overseas due to the exploitation of these organisations control over gene patents. In the 4 Corners piece it clearly outlined the issues where desire for profit outweighs patient care. I would like to point out that in no way am I condemning the medical profession at all, however in many industries that there are those who are motivated by other things and may work outside ethical boundaries and create ethical dilemmas which need to be addressed. I also worked in the pharmaceutical industry in sales early in my career and I had major issues with how the industry tried influence doctors then and now.
This brings me to ask you a couple of questions:
Does your organisation have a code of conduct or patient charter which takes into account the the balancing of profit and patient care /well being?
Do you think that more debate needs to be had around this topic?
I would be genuinely interested to know.
Thank you again for your interest and comments
cheers
Sue