Doctors 'put on notice' to report conflicts of interest

Ahpra is concerned emerging business models may be putting practitioners in a position where commercial or financial conflicts of interest may cloud clinical judgement.

It warned these business models have the potential to unduly influence the advice and treatment provided by practitioners, including businesses that advertise, prescribe and dispense a single medicine, or provide hidden incentives for practitioners to overservice or promote particular assessments, treatments or devices.

New interim guidance has been issued on managing financial or commercial conflicts of interest, outlining how practitioners should deal with certain scenarios to ensure they are acting in the best interest of patients at all times.

The guidance is supported by case studies to demonstrate how conflicts of interest should be managed in line with the code of conduct. The codes are currently under review, with the conflict of interest guidance expected to be updated once that review is complete.

Ahpra chief executive Justin Untersteiner reminded practitioners they must comply with their professional obligations at all times.

“The vast majority of practitioners put their patients first and do not allow their clinical judgement to be corrupted by outside influences. Ahpra is concerned others, including business owners, may put that relationship in jeopardy,” he said.

“Ahpra is reminding all practitioners they must comply with their professional obligations at all times. The onus is on practitioners to do the right thing, regardless of business model or employment arrangements.

‘We take action when practitioners depart from the acceptable standards and also have the power to prosecute those who incite practitioners to do the wrong thing. Patient safety is our priority.”

Case study: When business models influence care

Hannah, a medical practitioner, works for an organisation that exclusively offers and supplies treatment for weight loss. She is paid per consultation and makes a commission on the medicine she prescribes.

The business model relies on prompt prescribing, and Hannah’s assessment of patients is often limited to information provided through an online form completed by the patient before the consultation.

She does not discuss alternative medicines with her patients and instead provides prescriptions that are supplied by the in-house pharmacy and delivered directly to the patient’s address.

Potential conflicts of interest:

By only offering and supplying one medicine there is a financial benefit to the business each time that medicine is prescribed. The commission-based structure may incentivise Hannah to conduct shorter consultations, without undertaking a thorough assessment of patients before prescribing.

Hannah also receives a commission on the medicine she prescribes, creating a personal financial incentive to prescribe that medicine.

More about this conflict of interest, and other scenarios, can be found here.

It comes one week after Ahpra firmly put the unsafe prescribing of peptides and other medicines in its sights, issuing new guidance on the matter.

The regulator said it had been investigating unsafe prescribing practices, particularly in high-volume and single-treatment business models, including the provision of unapproved peptides, medicinal cannabis and GLP-1 weight-loss drugs.

It follows a spate of adverse events including liver toxicity, severe allergic reactions, inflammation and other health complications requiring medical attention have been linked to unregulated peptides.

In a statement this week, Ahpra said conflicts of interest are not uncommon in healthcare and while practitioners are entitled to profit from their profession, they must not cross the line into unprofessional conduct.

Practitioners should always be able to demonstrate that financial or commercial interests did not influence clinical decision making or patient care. They should also ensure that any assessment, treatment, medicine or device they recommend is based on their clinical assessment and is suitable for that individual patient.

“Ahpra is working with other regulators and agencies to share intelligence and data and be alert to any red flags that may indicate unsafe practice,” Mr Untersteiner said.

“We want anyone with concerns about a practitioner to contact us immediately. And we also want to hear about any individuals or businesses that may be pressuring practitioners to do the wrong thing.”

The interim conflict of interest guidance can be read here.

Information on emerging risks and business practices that may impact public safety can be reported here.