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For those who have chosen the path of medicine as a profession, one of the most symbolic moments is when you are first presented with and subsequently don the white coat.
This typically happens at the beginning of your first year in medical school during an auspicious ceremony.
In a profession where its practitioners are often subjected to encountering all sorts of bodily fluids, such as blood and vomit, it may seem strange to the lay person that the chosen uniform color would be white.
After all white clothing does draws attention to these potential stain inducing materials.
Of course the color white was chosen as another symbolic gesture as it is supposed to reflect the purity of the wearer of the white coat.
Even though every physician is sworn to Hippocratic Oath, it would be incredibly idealistic to expect a 100% compliance rate.
Every profession has its share of bad seeds and the medical profession is certainly not exempted from this.
Some actions might be considered to fall in a “gray area” while others can be downright illegal.
Looking A Gift Horse In The Mouth.
It is not uncommon for individuals who are in leadership positions to find themselves surrounded by people trying to curry their favor and have some influence on subsequent decisions.
Politicians are notoriously known for being swayed by lobbyists who line their campaign coffers with small fortunes.
If you are elected primarily because of a certain lobbyist’s contributions, you are more likely to enact policies that would protect that particular lobbyist’s interest in the future.
To do otherwise would be killing the golden goose.
Similarly physicians can find themselves surrounded by individuals hoping to influence their medical decisions for equipment purchases or medicine recommendations.
When I was in my first 2 years of residency as a general surgeon (before switching to radiology), I was constantly bombarded by pharmaceutical reps who would provide numerous luncheons as well as take us on some great experiences (a 3 hour road trip to spend a day deep sea fishing was probably the most extravagant).
It was during these encounters that the residents would be given all sorts of small items, the most common being very well made metal pens that happen to have the drug (most commonly an antibiotic) they are peddling emblazoned along the side of it.
When writing post operative orders, it was pretty easy to look on the pen to see the correct dosage, etc of that particular product and go ahead and prescribe it.
Apparently I was not the only one influenced from these tactics as a study now shows that docs who have received these benefits tend to prescribe more brand-name drugs.
I do not feel I was doing harm to the patient, and violating the Hippocratic Oath in the process, but I was definitely not doing an exhaustive search for other suitable medications which may have been a less expensive but just as efficacious alternative.
I do know that this particular practice has curtailed quite a bit thanks to some legislation preventing pharmaceutical companies just gifting doctors items and meals without some sort of educational component present.
But to say that this practice is now completely eliminated would be naive.
“If the only tool you have is a hammer, you tend to see every problem as a nail.”
We are now starting to get into the darker shades of gray that may start toeing the line of sound medical practice.
Years ago it was not uncommon for a small medical practice to invest in an expensive piece of equipment, such as a CT scanner.
With such a large capital expenditure, as well as high ongoing operating costs, these practitioners needed to make that item cashflow as soon as possible.
What better way to do that then to start ordering CT scans left and right on patients that might not necessarily have needed them?
A similar phenomenon was occurring with practices that owned a private lab.
When a physician has a vested financial interest in a service that he or she prescribes for a patient, it is considered a self-referral or medical kickback.
That physician receives greater profit from the patient encounter by ordering that particular service and therefore can be viewed as being incentivized to do so.
Apparently the problem became large enough that federal intervention had to be required and the Anti-Kickback or Stark Law was formed.
The penalties for violating the Stark Law can be substantial, as evidenced by “9 Crazy Examples of Surprising and Expensive Stark Law Violations,” totaling over $500M in fines.
Tarnishing the White Coat.
Finally we come to the section where physicians have completely crossed the line of sound medical practice and have entered the criminal world instead.
Sometimes the pull of money is too great and the physician turns to the dark side in order to sell his or her soul for more.
There are numerous examples of how physicians commit medicare fraud by billing for patient services that they indeed did not provide.
In a scene right out of a medical TV show, a Texas rheumatologist would falsely diagnose patients with diseases that required lifelong treatment with expensive medical infusions, defrauding medicare of a whopping $325 million.
That totally disregards the Hippocratic Oath, with direct harm to the patient both psychologically and physically by first diagnosing them with a false debilitative medical condition and then infusing them with unnecessary and potentially toxic material into their bodies, all for the sake of the dollar.
Then there are countless horror stories of physicians treating patients while under the influence of some mind-altering substances.
Apparently it is not unheard of for medical practitioners to “appropriate” some of the controlled substances, that were intended for patients, for their own personal use.
Finally there are what I consider the lowest of the lows in the medical profession, those that take advantage of vulnerable patients, often sexually, by abusing the power of the doctor-patient relationship.
One of the most recent high profile examples involved Larry Nassar, the US Women’s Nationals Gymnastic team physician who was convicted of sexually abusing over 250 young girls during his tenure.
Dr. Nassar is essentially serving a life sentence without parole for his crimes and is truly a black stain on the white coat.
The vast majority of the medical profession is composed of individuals who have sacrificed many things in their lives in order to gain the knowledge to help their fellow humans.
It is a profession that draws in people who have compassion and intelligence.
But like any profession there can be a bad apple or two that can spoil the barrel.
Because it brings higher ratings, the media tends to sensationalize crimes when a doctor is involved.
Unfortunately the byproduct of this is that the public perception of doctors as a whole turns for the worse because of the acts of the few.
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