Conflict of Interest Part 1
Janice is a physiotherapist who works part-time for a community agency and sees clients in their homes. Recently Janice talked to a friend of hers who sells orthopedic neck pillows. The friend told Janice that the pillow is wonderfully comfortable and helps to relieve neck pain and stiffness. She suggested that Janice could sell pillows directly to appropriate and interested patients and receive a commission for the sales.Janice treats many patients with neck pain and wonders if the pillows would benefit them. She would never recommend a product that she doesn't feel provides therapeutic value. Janice decides to borrow a pillow from her friend and try it for a week. She finds the pillow very comfortable and thinks that it may provide benefit for some of her patients. She agrees to offer it for sale to patients with the stipulation that if patients do not like the pillow they can receive a full refund.
Understanding Conflict of Interest
Conflict of interest occurs when a physiotherapist is in a position in which his or her professional judgement concerning the proper care of a patient could be unduly influenced by a secondary interest such as profit from a sale.Ethics
Janice believes the pillows will benefit some of her patients and she could also use the extra money she will earn through sales. She believes she is acting in her patients' best interests. What Janice has not considered is that she may jeopardize the relationship of trust between patient and physiotherapist. If a patient perceives that Janice is motivated by her desire to make money rather than her desire to pursue the patient's well being, the patient may lose trust in Janice and possibly in the profession. Regardless of what Janice's actual motivations are, it is the perception of possible inappropriate behaviour that can damage the relationship.There exists an inherent imbalance of power in any health practitioner- patient relationship. Physiotherapists have authority, special knowledge, and access to resources that patients do not. Thus patients are in vulnerable positions in relation to their physiotherapists.
Think of the situation from the patient's point of view. Individuals who depend on health professionals for their care may worry about disappointing the professional if they do not go along with suggestions for purchasing products. They may feel obliged to purchase a product out of fear that if they don't, the relationship will become strained and their care may be compromised.
The Standard for Practice: Conflict of Interest indicates that physiotherapists should avoid situations where their judgment has the potential to be compromised by either personal relationship or financial interest.
In situations where conflict cannot be avoided, disclosing the conflict and offering alternatives, where possible, is expected.
Policy
If a registrant has an interest in the sale of a health-care product, the College would consider it a conflict of interest if the registrant failed to disclose his or her interest (i.e., profits) in the product and offer alternatives before advising a patient to buy the product.Conflict of interest policies recognize that whenever there is a competing interest, a potential exists for the health professional to act inappropriately. This does not imply that most physiotherapists would allow their profit motives to rule their behaviour. Rather it implies that some will. Thus general conflict of interest rules err on the side of prudence to protect the public interest.
How to Approach Conflict of Interest in Practice
In the scenario, Janice stands to personally gain from the sale of the pillow and is therefore in a conflict of interest position. What should she do?Janice has a number of options open to her. She could:
- decline to sell the pillows;
- sell the pillows at cost and therefore not profit from the sales; or
- continue to sell the pillows provided that she discloses her interest in the sale to each patient and informs the patient where else he or she can purchase the pillow and assures the patient that his or her care will not be compromised regardless of the patient's decision to purchase or not to purchase the pillow.
