By Wong Tien Hua
There is an inherent conflict of interest when doctors practise medicine as a business, especially in a for-profit healthcare setting.
Commentary
As doctors, we are called to the service of humanity. Unfortunately this does not mean that we are spared the reality of having to make a decent living. This is especially pertinent in the private sector, where medical practices are businesses, dealing with increasing overheads, and with the constant possibility of economic failure.
Therefore, we need to charge a reasonable professional fee and bill patients equitably for services such as investigations and procedures. At the same time, we cannot exploit patients for monetary gain, and we need to exercise restraint in the face of commercial pressure.
The considerations involved in charging a patient underpin the perennial tension between professionalism and commercialism, and between altruism and self-interest. In primary care, the family physician is interested in developing a long-term relationship with his patient. He will not benefit if he sets his fees beyond the reach or trust of his patient.
In the drawing, the doctor’s consultation fee costs three $ signs. The magnetic resonance imaging costs the equivalent of seven $ signs. Rising demand for the latest technological scans and other expensive tests tend to overshadow the doctor’s professional assessment. This is ironic. It is the doctor’s assessment that the patient should ascribe the most value to, because the doctor’s clinical judgement is uniquely tailored to him as the patient.
Left unchecked, commercial interests may erode the value of a good clinician.
——-Dr Wong Tien Hua
Dr Wong Tien Hua is in private practice and is a past president of the Singapore Medical Association. His interests are in primary care, medical ethics, and patient-doctor communication.
The commentary and vignette were reproduced with permission from the book “Being Human, Stories from Family Medicine” edited by Cheong Pak Yean and Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore.
Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by A/Prof Cheong Pak Yean. Senior family physicians subsequently shared vignettes and commentaries based on the pictures.