The ‘Comminisure’ Scandal broke this week putting a media focus on the role of doctors within organisations and the potential for commercial interests to over ride the usual ethics of the medical profession.
For those who didn’t watch 4 Corners here is a link:
Link to 4 Corners – ‘Money for Nothing’
The Conversation on-line news published an incisive article authored by bioethicists in response :
Comminsure scandal reminds us commercial forces are at play in medicine
This article emphasises how doctors involved with insurers can get caught up in the commercial interests of the business with adverse effects on patient care. The authors emphasise how this current scandal demonstrates issues that arise with conflict of interest:
They state:
‘The phrase “conflict of interest” refers to situations in which there is a tension between “primary” values or commitments (interests) and the other “secondary” interests’
The primary value for doctors is that of the medical interests of the patient, described as ‘patient well-being’. Secondary interests can conflict with this primary value. Examples are provided of the potential conflicts that arise with doctors employed by insurance companies, sporting clubs, prisons and refugee camps and for occupational physicians employed by major companies. Does this issue extend to doctors employed in hospitals and government roles?
The key paragraphs in the article are quoted below:
‘Because doctors are so powerful, and because enactment of these powers can have major consequences for vulnerable patients, it is essential doctors always use their skills and authority to act in the patient’s best interests’
and
‘Any relationship that has the potential to get in the way of this primary commitment needs to be navigated with the utmost care. The obligation remains even when doctors work for, or within, an industry that appears to have lost its moral compass’
The Comminsure Scandal brings to the fore another ‘elephant in the room’ in our compensation systems. While the previous ‘elephant’ I referred to in How Big Is the Elephant in the Research Room? is getting smaller with increasing evidence and understanding about the factors that affect outcomes in compensation systems, the hidden conflicts affecting doctors with important roles in our compensation systems has received inadequate attention. It is important that those employed doctors perform a self-analysis, and ask the following questions in relation to potential conflict of interest posed in educational material from the Australian Institute of Company Directors (AICD):
‘Do I have a conflict of interest?
If you think you might have a conflict of interest, ask yourself these questions:
- Would someone from outside the company or outside my family think I have a conflict of interest?
- What would I think if I heard of someone else doing this? Would I think there was a conflict of interest?
- How would I feel if my actions were printed on the front page of the newspaper?
- Who could be disadvantaged and who could benefit from my actions?
- Do I need to get an independent opinion about these issues?’
This scandal has also highlighted issues with excessive use of covert surveillance by insurers as detailed in the Sydney Morning Herald.
SUMMARY
The Comminsure scandal highlights potential issues where doctors are employed by or contracted to organisations that administer or oversee our compensation systems. These factors may contribute to poorer health outcomes in our workers compensation schemes than might otherwise occur if such doctors adhered to fundamental principles i.e. having primary concern for a patient’s or injured worker’s best interest and always using their skills and authority to act in the patient’s best interests.
Perhaps this issue is more important than the conflict that can arise with a doctor’s personal interests to earn a salary, care for their family, maintain a practice and advance their career as can arise in a typical practice setting.
Over to ISCRR to do the research!
Insult and Injury 
Peter, there is little left to say on this topic. However, for the record, it is my impression that our money-oriented society actually condones these nefarious activities being performed by personal injury insurers and their preferred medical advisors. Even more worrying to me is that professional bodies such as the Australian Medical Association and the various colleges have turned a blind eye in the direction of such gross breaches of medical ethics. In my opinion, you are doing great work in an endeavour to repair the damage. I hope that others of our colleagues decide to follow in your footsteps.
Thanks John – I agree the AMA should be doing more.
Lots of views of the article, particularly today, but no more comments on this site. Like to see comments from the insurance industry. Only one comment in Workers Compensation Australia Group on LinkedIn putting the focus on doctors and their incomes from treatment as well as from IME work. Should be an interesting discussion there.
In the words of Martin Buber, “independent” medical examiners within our systems of Workers’ Compensation are mandated to approach injured workers as “I-It” rather than “I-Thou”, thereby effectively depersonalising them as they struggle to survive within an unashamedly adversarial system. As we know, the AMA “accepts the responsibility for setting the standards of ethical behaviour expected of doctors.” Surely then, the “I-It” approach is quite contrary to the AMA’s Code of Ethics.