Saturday, June 7, 2008

When the Doctor Becomes a Merchant

Backending - Selling Stuff to Patients
By Leslie M. Wise, D.C.

A definition is always in order when a new term is being put forth, especially if that term may have diverse meanings in multiple contexts. “Backending” is used in the computer industry, to differentiate hidden, unseen parts of an application from the visible, user interface. It is used in demographics and data collection to distinguish intentionally collected information from information which must be secondarily gleaned from the original entries. In sales, it means selling someone something they didn’t come in to buy. It is in this latter context that we will consider the extremely common practice of chiropractic backending, which occurs when a patient comes in for chiropractic services and leaves with two sets of orthotics, six bottles of vitamins, a knee brace, a carpal tunnel strap, a $200 pillow and a lifetime subscription to Chiropractic Health magazine.

I can already hear my detractors: “But all those things are good for the patient. We’re doing them a great service!” That was the excuse of the Myrtle Beach chiropractor busted by the board of examiners in the early 80s for running nude hot-tub encounter groups in his office. His logic was that the sessions reduced stress, and lower stress means better health. Whether or not things are good for people is not the issue here. We will come to the true issue shortly.

One of the differences between a hardware store owner and a doctor is that the store owner is a merchant and the doctor is a professional. The merchant subscribes to the mercantile ethic of “buyer beware,” and the doctor is beholden to the professional ethic of “let the buyer trust.” The mercantile ethic may consider fair and honest service, but is primarily concerned with a profit motive and the merchant’s best interests, whereas the professional ethic must consider altruistic service and the best interest of the patient always must be supreme.

When a doctor starts selling merchandise in a professional office, an immediate potential conflict of interest is created, causing the schizophrenic doctor to choose between serving the patient’s best interests and selling those 10 cases of special feel-good vitamins before they expire next week. The patient is placed in the uncomfortable position of deciding whether to be compliant with the doctor’s recommendations, or buy his vitamins at Wal-mart. He risks the doctor’s displeasure while making an economic decision, and is obviously reluctant to alienate this person because of his authority position.

Professions have created codes of ethics that specifically address the subject of conflicts of interests. They generally advise that professionals, because of their adherence to higher ethical standards than the general public, should scrupulously avoid conflicts, and even avoid the appearance of conflicts by always taking the high road in matters of money and profit.

Read it all here.

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