Task force 4: Appropriate clinical care and issues of “self-referral”

Abstract

“Professionalism is the basis of medicine's contract with society. It demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health.... Essential to this contract is public trust in physicians, which depends on the integrity of both individual physicians and the whole profession” (1). Cardiovascular specialists support the fundamental principles of primacy of patient welfare, patient autonomy, and the promotion of social justice. For the purposes of this document, “self-referral” occurs when a physician recommends a patient intervention from which the physician may benefit personally. Such recommendations usually facilitate the provision of efficient, effective, and high-quality care, but may also afford the potential for abuse. As former JACC Editor-in-Chief William Parmley stated so clearly: “At issue is the question of intent; if the intent is to provide excellent medical care, the practice is laudable. If the intent is to subjugate medical decision-making, then the practice is unethical” (2). Those few physicians who are publicized for violating our trust do not reflect the rank and file of cardiovascular specialists. The cardiovascular specialist's primary duty is to the patient. His or her role is to promote patient welfare in an increasingly complex health care environment, one that has been made even more complex by the anti-kickback statutes and Stark laws (see the following sections). Having entered into a physician-patient relationship, physicians must counsel their patients regardless of individual financial or medical care delivery system considerations or other factors, such as socio-economic status, race, gender, or sexual orientation (3). The physician's clinical judgment must not be influenced by financial incentives from a fee-for-service system or disincentives from a capitated care system. Recommendations should be made based only on medical merit (4,5). Physicians must …