Page 5 - Mecklenburg_Medicine_April-2018

President’s Letter
Is There a Conflict?
By Scott L. Furney, MD
M y father passed away four years ago. The lessons
I learned from that experience are profound,
and more than I can share in one article. Part of
that journey included learning skepticism of our
profession, which can have a dark side.
My father initially was hospitalized with shingles and an abnormal
CBC. I flew up to Michigan a few days later, as his workup was
unfolding. Only after significant prodding did his hematologist tell
me he thought my dad had chronic lymphatic leukemia and a bone
marrow biopsy would confirm it. I did not know the physician, but
was told by the hospital team that we were lucky to have him assigned
to my father’s case.
Fast forward a week; his bone marrow confirmed CLL, and it
appeared to be stage 0, which was good news. Then things got weird.
I received his records from his less-than-forthcoming hematologist.
My father had adequate bone marrow iron stores, but his treatment
included an additional set of office-based iron infusions. I called the
physician, asking politely, “Why are you giving him iron infusions
when his bone marrow iron stores are normal?” The shocking answer
from an eminent board-certified hematologist was, “Because he is
anemic.” Let that sink in …
I returned to Charlotte, and a few days later my sister called,
informing me my father was scheduled for “urgent” chemotherapy.
Given that he had stage 0 disease and was recovering from shingles,
this made no sense to me at all. I am not a hematologist, but I know
some really smart ones. A quick collegial consultation later, I called
my father’s physician and told him his service no longer was needed.
My father was mortified; not with his physician, but with me. As a
trusting baby boomer, he could not fathom how a physician might
not have his best interest at heart. Imagine how hard it was for me to
tell my father that his physician was less interested in his health than Online
his insurance payment. In case you are wondering if I over-reacted,
his physician has since lost his license and is in federal prison for
Medicare fraud. The link to the article is at the end of this letter.
Why do I tell this story? Having been sensitized, I now see
conflicts of interest in almost any place I look. The literature is full
of articles describing how compensation systems can drive overuse
when physicians benefit. Stark Law, among others, is there to ensure
we minimize the risks associated with physician self-referral. The
problem still exists. Atul Gawande wrote a great piece in “The New
Yorker” called “The Cost Conundrum” in 2009. I highly recommend
you read it. Two lines distill the essence of the conundrum:
“Somewhere in the United States at this moment, a patient with
chest pain, or a tumor, or a cough is seeing a doctor. And the damning
question we have to ask is whether the doctor is set up to meet the
needs of the patient, first and foremost, or to maximize revenue.”
The lack of insight we have into our own potential conflicts
is best highlighted by surveys of physician attitudes toward
pharmaceutical sales events. About 20 percent of physicians
believe they could be influenced by a marketing event, but they
think 80 percent of their colleagues could be. We are capable of
turning a blind eye to the things we justify.
I have been on the soap box long enough. While 99 percent of us
provide high-quality care with no apparent conflicts, I suspect there
are conflicts below the surface we need to examine critically. There
are a handful of our colleagues we have an obligation to uncover and
report, for the sake of our patients and profession. The only thing I
regret in managing my father’s care team is that his physician practiced
for another year before he was indicted and removed from his practice.
How many patients did he treat after I recognized the problem?
In humble service,
Link to the news coverage of the hematologist:
https://www.cnn.com/2015/07/10/us/michigan-cancer-doctor-
sentenced/index.html
CHARLOTTE AHEC COURSE OFFERINGS
Charlotte AHEC is part of the N.C. Area Health Education Centers
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APRIL 2018
Continuing Medical Education (CME)
4/6 Partners Health Summit: Solutions to North Carolina’s Opioid Epidemic
4/28-29 32nd Annual Meeting of the GDCN
Online Protecting Your Patients From Air Pollution
Online Risk Management: Patient Identification
Online Social Media: Risks and Benefits for Physicians
Online Prevention and Management of Concussion/Mild Traumatic Brain Injury
Online Motor Vehicle Crash Victims
MTAC Trauma Modules
Online Get the 4-1-1: Everything Primary Care Providers Should Know About
Parent Training in Behavior Therapy While Working With Families With
Young Children With ADHD
Online Electronic Medical Record on Trial (Risk Management)
For more information or to register for these courses, call 704-512-6523
or visit www.charlotteahec.org.
Mecklenburg Medicine • April 2018 | 5