Ask the Expert ~ What Do I Do If My Colleagues are Unethical?

This New York City MD practices with colleagues who run their patients through an assembly line of unnecessary tests and procedures out of greed and worse. He hates what he sees, but is unsure what he can do about it.

Hello,I am a Board Certified Family Physician in New York City and I see a number of colleagues doing procedures and tests, totally unnecessary and are done for greed and/or to please or to deceive the patients. I am sort of frustrated as I feel the colleagues are spoiling the practice of medicine with gadgets and flooding the patients with tests that are not ordered for the best reasons. I certainly don't want to join in this type of practice of medicine. Any advise?

Shirley Mueller, MD - My Money MD

Dear Doctor,

What you describe is probably wide spread. I can say this both as a physician and a patient. When I practiced neurology, there were doctors who were known to test more than others. On the other side of the reflex hammer, as a patient, I feel tests have been suggested for me that were not needed. You are right. It is not what medicine is all about.

That being said, there is another side to the story. Doctors who work with the “worried well,” patients, who have the luxury of time to think about themselves and their ailments, may have to do generous testing because the patients wants or even insists on it. They go to their doctors to prove they don’t have what they think they do.

If the MD doesn’t comply, they will go elsewhere. In the worse possible case, the doctor who didn’t test could be sued if the patient ends up having something not discovered by history and examination alone. This means there is some credible justification for these physician’s actions.

On the other hand, other doctors test endlessly with little apparent purpose except to make money from the tests. Theses physicians justify their actions to themselves because the practice of medicine is difficult; they are taking risk by being a doctor; in addition they may feel they have a short time to earn money. They therefore try to maximize income when they can.

If you don’t do this in your own practice, more credit to you. However, I’m not sure it means that you can judge the actions of others. It would seem the main thing for you is to be true to yourself. If acting like others would make you feel uncomfortable, don’t do it. You have to decide for yourself, but not for them.

If your dilemma is whether or not to be a whistle blower, that is another issue. There are books about people who did this, not in medicine, but other fields. My take is that it is not an easy course and could disrupt your current life style in a way you might not find pleasant. However, if you chose to do this, you would have to pick your case carefully.

In other words, it would not be a doctor who over tests to head off a malpractice suit or because the patient needs it to reassure himself, but physicians who more clearly are doing unnecessary testing only for the money gained and deliberately deceiving their patients in the process.

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