Sale of Non-Health-Related Goods
from Physicians' Offices

AMA Council on Ethics and Judicial Affairs Report 5-I-97

A number of physicians are engaged in the sale, from their offices, of such non-health-related goods as household products and magazine subscriptions. This report addresses certain important ethical problems with such sales, and sets guidelines for the sale of such goods in those few circumstances when such sale is appropriate.

I. Ethical Problems with For-Profit Sales of Goods

A. Conflict of Interest

The for-profit sale of goods to patients by physicians inherently creates a conflict of interest. Physicians engaging in this activity have a direct financial interest in selling the goods to patients; but the sale may or may not be in the best interests of the patients. Physicians may be tempted to sell items for profit even though their patients do not need the products. Even if most physicians are capable of resisting such temptation, the more ethical course is for professionals to avoid placing themselves in temptation's way, This conflict of interest is particularly troubling in the office setting, where most patients appear because they are in need of medical attention. In the ordinary market setting, consumers can be trusted not to purchase items which they do not want, thus a voluntary sales transaction is taken to be in the best interests of both parties. But the voluntariness of any sale to a patient in a medical office setting is open to serious question.

B. Inherent Sales Pressure

The offer of goods In the treatment setting puts subtle pressure on sick and vulnerable patients to purchase them. Patients may purchase goods out of a misplaced desire to please or to "get in good" with their physicians. They may feel that they have to purchase those goods in order to secure the physician's favor. These feelings, whether justified or not, may interfere with the open exchange and the level of trust between physician and patient

C. Demeaning Medical Practice

Sale of goods in treatment settings also risks demeaning the practice of medicine. The basis of a good patient-physician relationship is trust. Such trust is undermined whenever physicians, through their behavior, equate the office setting with the supermarket or the bazaar.

II. Sale of Goods At Cost; Free Goods

Except in the case of the narrow exception noted below, even at-cost sale of non-health-related goods from the office is inappropriate. Such sale has no health benefits to patients. While it does not involve physicians in financial conflict of interest, efforts at such sales can affect the quality of the patient-physician relationship and can demean the practice of medicine.

Free distribution of non-health-related goods in the office is permissible, provided that it is conducted in a dignified manner,

III. Exception for Sales for Community Benefit

Certain kinds of sales are bound up with service to the community (e.g., sale of Girl Scout cookies, children's "band candy," tickets for a hospital benefit function). Even sales of such goods can threaten the patient-physician relationship—as for example, when a physician offers church raffle tickets to a patient of another faith—and can, if conducted improperly, demean the practice of medicine. However, undertaken in the proper manner, such sales are permissible. Such sales are acceptable provided that a) the goods in question are low-cost, b) the physician takes no share in profit from their sale, c) such sales are not a regular part of the physician's business, d) sales are conducted in a dignified manner, and e) sales are conducted in such a way as to assure that patients are not pressured into making purchases. One good technique for conducting such sales without exerting unwarranted pressure upon patients is simply to post a sign noting the availability of the product. This allows patients to express interest or not, without the physician's initiating direct personal communication.

IV. Conclusion

Physicians are not simply businesspeople with high standards. Physicians are engaged m the special calling of healing, and, in that calling, they are the fiduciaries of their patients. They have different and higher duties than even the most ethical businessperson. This is the teaching of the Hippocratic oath ant of the great modem teachers of ethical behavior. There are some activities involving their patients which physicians should avoid whether there is evidence of abuse or not [2]. With one very narrowly delineated exception, the sale of non-health-related goods from physicians' offices is among those activities to be avoided.

Recommendations

1. Physicians should not sell non-health-related goods from their offices or other treatment settings, with the exception noted below.

2. Physicians may sell low-cost non-health-related goods from their offices for the profit of community organizations, provided that (a) the goods in question at low-cost, (b) the physician takes no share in profit from their sale, (c) such sales are not a regular part of the physician's business, (d) sales are conducted in & dignified manner, and (e) sales are conducted in such a way as to assure that patients are not pressured into making purchases.

This page was posted on July 14, 1999.

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