Running head: HEALTHCARE PRACTICES

Healthcare Practices
Mesha Dennery
Name of the University

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Introduction
There are various business layers that are present in a healthcare organization. At the
time that a person visits a hospital, the main focus of the person is on the services and the
manner that they are able to recover, and not on the business plans of the hospital and the
facilities. Similarly, there are different stakeholders in health care industry, who have
different interests and focus areas. Consequently, there are several parties that influence a
healthcare organization as well as the overall healthcare industry, leading to professional
conflict between these stakeholders pertaining to the various practices in healthcare. This is a
complex structure; however, its presence is unavoidable because there are various services
that together make the health care sector.
Due to the difference in the interests and/or expectations of diverse groups of
stakeholders, it is usual that conflict of interest exists for the significance or attractiveness of
various facets of strategy. The distinctive expectations of stakeholder comprise of the
conflicts amid development and productivity; expansion and control; cost efficiency and jobs,
etc. In these instances, there is a compromise made in one segment to attain the development
in the other. (Lynch, 2003)
This paper analyzes the least three health care practices that create conflicts of interest
for the stakeholders involved. For each practice analyzed, a strategy has been proposed to
eliminate these conflicts. There are overall recommendations also includes, from an ethical
standpoint, for eliminating conflicts of interests in the three areas of conflict.

Practices that Create Conflict of Interest
There are several practices in the healthcare industry, which tend to create conflict of
interest between stakeholders. There is a group of sales and marketing that is focused on
augmenting the sales and product distribution. They tend to sometimes ignore the seriousness
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of health of patients and believe that this aspect would be dealt by other stakeholders. The
various pharmaceutical companies, the organizations dealing in medical equipments, or the
supply organizations put their best efforts in promoting the new products. The marketing
practices that these companies undertake focus on the profitability rather than the needs and
reactions of the patients.
The three healthcare practices that are noticed for creating conflict of interest and
would be discussed subsequently are provision of pharmaceutical samples, gifts (including
meals), as well as research project grants (Harrington & Estes, 2008). These conflicts arise
quite frequently, which is the main reason behind their selection. It is necessary to understand
and develop strategies to evade such conflicts because at certain times, such practices tend to
cross the line concerning the wellbeing of the patients. It can be said that the health of the
patient is sacrificed for earning revenue.

Pharmaceutical Samples
One of the ways that the conflict of interest arises is providing of pharmaceutical
samples to offices of the physicians. This practice has been in use for several years. A
representative from the pharmaceutical company visits a facility in healthcare, meets with the
management for informing them about the benefits of the product. Before the meeting is
finished, the representative leaves certain samples of the product/medicines with the
physicians to be given to the patients. The main idea for the samples to be left is the
promotion of the product, with the expectation that the physicians would prescribe these
medicines regularly. This would help in augmenting the profits of the pharmaceutical
company. Here, the conflict is between physicians interest on the well-being and cost
effective treatment and that of the pharmaceutical company to increase the profits.

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Strategy to Eliminate Conflict
The strategy here is to be as specific as the medical profession is. The physicians can
analyze the applicability and compare it with the other drugs available, and answer the drug
representative if these drugs can be prescribed or not, considering the other available
medicines. The idea is to rationalize on the best possible option, rather than rude and direct
denial without evidences. (Chimonas, Brennan, & Rothman, 2007) Also, if it is not a private
physician, works from another healthcare center, stricter control can be made on such
distribution, and the physicians should prescribe the drugs that are approved by single
authority, which speck with the drug representatives.

Gifts and Meals
There is a conflict of interest if the physicians accept gifts (including meals) from a
third party, which is working towards promotion of their business. There can be influence
posed by the gifts, even when they are not very expensive. There cannot be put forward any
reasons that help in justifying the receiving of gifts from any marketing or other business,
without seeing the risk of bias and the loss of public trust. In these cases, the physicians are
offered pens, diaries, cases, highlighters, as well as professional bags to promote the
medicines of the organization. (Lo & Field, 2009)

Strategy to Eliminate Conflict
To eliminate such conflict, the various pharmaceutical companies must have practices
and policies in place against offering the gifts and meals to the physicians or other such
things that have value. In addition, the physicians should not be offered to be authors of
materials that are ghostwritten. Consulting arrangements should be for necessary services,
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documented in written contracts, and paid for at fair market value. Companies should not
involve physicians and patients in marketing projects that are presented as clinical research.
(Lo & Field, 2009)

Research Projects Grants
There are the grants for research projects and this segment is also a healthcare
conflict, addressed continuously. There are times that pharmaceutical companies or an
o9rgnaization that undertakes medical supply offers grants to research facilities. This is
conducted with the aim that the product of the company that offers grants would be used at
the time that the researches are conducted. (Palmer, BraunackMayer, Rogers, Provis, &
Cullity, 2010) With this, the pharmaceutical companies would gain access to the accurate
information and data concerning the product or medication that is created.

Strategy to Eliminate Conflict
The strategy that can be followed for eliminating such conflicts is to have the policies
on grants on the institution-level. There should be a committee that has people from various
healthcare domains as members. This committee should be responsible for accepting any
grants considering and studying the rationale of the organization that is giving the grant.
As per Wall Street Journal Europe, conflicts of interests may influence research,
education and clinical decision-making in ways that compromise clinical integrity and patient
care, and may lead to increased health care costs. (Stossel, 2012) It has been noticed that the
drugs promoted by different pharmaceutical companies are quite costly in comparison to the
other drugs.


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Recommendations
It is unethical to accept gifts from, prescribe drugs of, and take grants from a
pharmaceutical company just because there is a personal benefit provided by these companies
to the physicians or the health care organization in particular.
It is recommended that at the time that the physicians are at the site of clinical
practice, they must
Refuse to receive any gift that has material value and provide legitimate service;
Refuse to make educational presentations or publishing any articles related to science,
particularly the ghost-written ones;
Not undertake any consulting arrangements till the time that there is an order to do so
or there is a written contract in place;
Refuse meeting with any sales representatives, if they have not taken prior
appointment or if they are not explicitly invited.;
Refuse acceptance of any drug samples, unless it comes from authorities or to offer it
to patients who can be given the drugs at no or lower price;
The various professional healthcare services and communities must conduct
appropriate amendment to the policies as well as the code of professional conduct for
supporting all of the above-mentioned recommendations.

Conclusion
There are various situations of conflicts of interest that arise in a healthcare sector,
just the way that it arises in any other industry. However, due to the sensitivity of the
industry, it is important that due care and attention is given to these conflicts because
ultimately, the patient is the stakeholder, who would suffer because of the conflict of interest
of various other stakeholders group. While the organizations should ensure that there are
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policies and practices in place to avoid such conflict, the physicians should deal with the
situations in an ethical manner.

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References
Chimonas, S., Brennan, T. A., & Rothman, D. J. (2007). Physicians and Drug
Representatives: Exploring the Dynamics of the Relationship. Journal of General
Interim Medicine, 184190.
Harrington, C. & Estes, C. L.(2008). Health policy: Crisis and reform in the U.S. health care
delivery system (5th ed.). Sudbury, MA: Jones and Bartlett.
Lo, B., & Field, M. (2009). Conflict of Interest in Medical Research, Education, and
Practice. Washington (DC). Washington DC: National Academies Press (US.
Retrieved from
http://www.ncbi.nlm.nih.gov/books/NBK22944/#_ncbi_dlg_citbx_NBK22944
Lynch, R. (2003). Corporate Strategy, 3rd Ed. Prentice Hall: Pearson Education Limited.
Palmer, N., BraunackMayer, A., Rogers, W., Provis, C., & Cullity, G. (2010). Conflicts of
interest in divisions of general practice. Journal of Medical Ethics, 715717.
Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563353/
Stossel, T. P. (2012, January 23). Who Paid for Your Doctor's Bagel? Retrieved from
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