Conflict-of-Interest Case Analysis
There are a number of ethical challenges faced by Kathy's provider in this case. Issues of disclosure, truth telling, protection of patient rights, preserving the nurse's integrity (by not ordering diagnostic work that is not needed -- both the patient's mother and the hospital are putting pressure on her to order this), transparency, accountability, and conflict-of-interest are just a few of the ethical challenges faced by the provider in this case. Each should be met as it arises and dealt with in the order that it appears over the course of the presentation.
The first challenge appears when the mother requests a chest X-ray, which is unnecessary at this stage (but because she has requested it and the practice manager wants diagnostic test stats up, it could be arranged to please both the mother and the practice manager). However, to protect the integrity of the nurse, it should be refused: if a nurse compromises her own integrity by ordering diagnostic work that is unnecessary it places a strain not only on her own conscience but also on the system as a whole. Unnecessary diagnostic work does nothing but move money from the patient's (or insurer's) pocket to the pockets of the hospital -- without any real or needed service being provided. The nurse who has integrity will be transparent and honest with the mother at this moment and say that such a test can be ordered but that at this moment it is not necessary, as there are a number of alternatives that can...
However, a second ethical challenge appears at this point -- and that is the recommendation of Kathy to see the MD, who is known for overprescribing and ordering unnecessary diagnostics tests. This would obviously please the mother, but it could be negative for the patient, who is the one who would actually be prescribed something she may not need.
If I were the provider, I would not even entertain the idea of recommending this MD, as his reputation speaks volumes. Indeed the clinic itself appears to have a conflict-of-interest at heart, as the practice manager has stated that he wants to see more diagnostic work being ordered. (Instead of ensuring that the right tests are being conducted, the manager is more focused on meeting quotas, thus indicating that the clinic is being run with a "profits first, people second" philosophy). With regard to this practice manager, I would continue to only order diagnostic work that I thought was in the best interest of the patient. I would go to work with a "patient first" mindset rather than a "profit first" outlook and recommend a change in the workplace environment (Page, 2004).
Another challenge appears when the mother urges the provider to sign a form saying that Kathy is not contagious so that she can go on the trip with her dance troop to Ontario. This is an ethical challenge related to honesty and transparency, truth telling and disclosure. For the provider to sign such a document would…
