Ophthalmology Business

MAY 2013

Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.

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continued from page 15 but you know there are many patients due refunds for the past five years. Now, let us hope that the number of ophthalmologists who would actually engage in such practices is minuscule. The ethical point I nevertheless want to make is that just like Lance Armstrong, ophthalmologists who would knowingly and willfully engage in fraud would probably rationalize their wrongdoing. They might deny that they are committing fraud at all; they might delude themselves into thinking that some of their colleagues do the same kinds of things so why not them; they might desensitize their moral feelings to downplay the gravity of their wrongdoing or minimize its significance; they might convince themselves that their reimbursements have been so unfairly reduced over the years that they must resort to such fraudulent practices just to survive. Notice how tempting it is to think like that so as to reduce and remove whatever guilt feelings might attach to committing the transgression. But consider the consequences. Once serious violations of the law or a physician's code of ethics are discovered, it's too late. And office 16 administrators who are aware of any kind of illegalities occurring in their practices should realize that by concealing the wrongdoing, they might be regarded as complicitous in it and face penalties themselves. Consequently, the best strategy is to address the temptation of wrongdoing directly because temptation will always be present. We must educate ophthalmologists and office administrators to understand what moral transgressions like fraud look like. We must admit how easy it can be to overlook such misbehaviors and, indeed, to "normalize" them as "business as usual." If we cannot teach people to be morally disgusted by unethical or illegal behaviors, then ophthalmologists and their administrative staff should be made acutely aware of the kinds of careerending penalties that physicians and their practices have suffered when they became ethically lax and callous. So, if the demands of ethics aren't powerful enough to discourage wrongdoing, then maybe the threat of the slammer might be. Ophthalmology administrators who find themselves doing things that cause them to feel uncomfortable should first determine whether Ophthalmology Business eZine • May 2013 their discomfort is justified or not— in other words, they should do their homework to determine whether the behavior in question is acceptable or not. If it turns out that it isn't, they must find a means to address it and implement a remedy. Failing that, they should quit and work somewhere else (and seriously consider reporting their experience to the authorities, which would require a column in itself). When ethical sensibilities break down, such as in Lance Armstrong's case, there can be unspeakable anguish and penalties. We should therefore be keenly aware as to how rationalization can blind us to our moral transgressions, and we should recognize but staunchly resist its seductive charms, literally at all costs. OB Dr. Banja is a professor and medical ethicist, Emory University, Atlanta, and public trustee of the ASCRS Board of Directors. He can be contacted at jbanja@emory.edu.

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