Issues in ethics: discarding doctors

The cases described illustrate a disturbing trend in medicine today, one that raises ethical issues about professional ethical values and the health care system that determines whether they will flourish or not. These cases illustrate failures of the peer review system in medicine, a quality control procedure that allows the profession to discipline members who are not meeting medical standards. For these physicians peer review was misused, removing competent physicians for primarily financial rather than medical reasons. Dr. Patrick was an economic competitor of the Astoria Clinic, Dr. Hillsman had sued his hospital for wrongful discharge, and Dr. Reid´s investigations threatened the economic security of Oak Ridge, which has an extensive nuclear industry. The reputations and careers of the accused physicians were severely damaged, not because they were bad doctors but because they threatened the economic interests of others. With the growth of managed care and other arrangements designed to cut health care costs, economic pressures on physicians will increase and one can expect to see a corresponding growth in abusive peer review.