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Perverse incentives

1 Nov 2013

Summary

Personal profit and/or incentives, financial or otherwise, should not affect your professional judgment. This includes referring patients and prescribing specific products.

Ethical position

The Singapore Medical Council (SMC) endorses the World Medical Association’s International Code of Medical Ethics.

This states that doctors should not receive any financial benefits or other incentives solely for referring patients or prescribing certain products. Doctors should also avoid charging or collecting excessive consultation fees.

Improper referrals

You may refer a patient to any hospital, nursing home, health centre or similar organisation if it is in the best interest of the patient. Referrals based on any inducement from an organisation should be avoided. Any financial interest in an institution must also be disclosed to the patient before making the referral.

Consultation fees

Consultation fees must be made known to patients if requested. An advance quotation should be supplied if substantial fees will be incurred. You should avoid charging or collecting excessive fees.

Professional fees should not be shared with any person other than bona-fide partners of your practice. However, it is acceptable to make payments to other doctors and healthcare professionals collaborating in the provision of bona-fide medical services to a patient, provided that the patient is informed of this involvement as soon as practicable.

Pharmaceutical industry

When prescribing a drug or treatment for a patient, your choice of medication or appliance should be based solely on the medical interests of the patient.

You should avoid accepting any inducement that may compromise, or that may be regarded as likely to compromise, your independent professional judgment relating to patients’ management.

You must not solicit or accept unreasonable sums of money, either as gifts or loans, or equipment or expensive items for personal use, from commercial firms that manufacture or market drugs or medical products. There are some exceptions, such as donations or grants of money or equipment to hospitals, healthcare centres and universities, specifically for patient services, education or approved research. These must go through the prescribed channels.

It is improper to receive payments or benefits from pharmaceutical firms:

  • in relation to a research project, such as the clinical trial of drugs and appliances, unless the payments have been specified in a protocol for the project, which has been approved by the relevant local ethics committee (other than the ethics committee of the sponsoring pharmaceutical firm)
  • under arrangements for recording clinical assessments of a licensed medicinal product, whereby you are asked to report reactions observed in patients for whom you have prescribed the drug, unless the payments have been specified in a protocol for the project, which has been approved by the relevant ethics committee (other than the ethics committee of the sponsoring pharmaceutical firm)
  • if there could be influence over your professional assessment of the clinical value of drugs or appliances.

Advertising

The SMC will take disciplinary action against you if you promote your practice in any form of advertisement issued in an organisation’s name.

This includes the publication of your professional fees or contact information in any promotional material produced by an organisation.

You should take care that any organisation you have a financial or professional relationship with, or which refers patients to you, does not contravene the principles of advertising for individual doctors.

Beware of perceived financial association with commercial firms and using professional status to endorse commercial products in the general media.

Sponsorship

Sponsorship by commercial organisations is acceptable if the amount sponsored is reasonable, and if it is for participation in scientific meetings or educational and charitable services.

Further information

Perverse incentives (November 2013)