Suppression of Medical Abuses

November 8, 1952

Report Outline
New Drive Against Unethical Practices
Legal Restraints on Medical Quackery
Self-Policing by Medical Profession
Special Focus

New Drive Against Unethical Practices

Commercial Abuses by Doctors and Surgeons

The medical profession is making a concerted drive against frauds perpetrated on the sick by im-posters and by dishonest or irresponsible practitioners within its own ranks. The American College of Surgeons, at its clinical congress in New York the last week in September, announced a renewed effort to stamp out certain widespread practices which it deems unethical. The surgeons took particular exception to “fee-splitting” and “ghost surgery”—practices which are condemned with equal vigor by the American Medical Association.

Fee-splitting involves payment by a medical specialist of a commission to the doctor who refers a patient to him. Ghost surgery is the practice of secretly assigning an operation to a surgeon who does not enter the operating room until the patient has been put under an anesthetic, and who departs before the patient has regained consciousness. Fee-splitting is an old abuse; ghost surgery a relatively new one. The ghost surgeon may be highly competent but 18 less well established than the surgeon the patient has chosen, who in effect sub-contracts the work at a fraction of the fee he will receive.

The opening sentence of the professional code of the American Medical Association states: “The prime object of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration”. Fee-splitting is specifically banned: “When a patient is referred by one physician to another for consultation or for treatment … the giving or receiving of a commission by whatever name it may be called or under any guise or pretext whatsoever is unethical”. The public has been warned by Dr. Alton Ochsner, a former president of the College of Surgeons, that fee-splitting is indicated when a physician does not offer a choice of surgeons for an operation, when the surgeon does not tell the patient the amount of the fee in advance, when a bill is received only from the surgeon, none from the physician.

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