This month we will consider the potential ethical pitfalls of costly new technology—and we want your help. Tell us how you would address this ethical dilemma by e-mailing firstname.lastname@example.org.
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Explore This IssueSeptember 2011
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My partners would like to buy an ultrasound machine to generate more income. I feel very conflicted because I am concerned that once we have the machine, we might be tempted to use the ultrasound more than necessary. My partners counter we are not being paid adequately for our cognitive services and this is the only way we will be able to survive professionally. However, I have several dilemmas. First, there is currently no standard of care or guidelines to establish when musculoskeletal ultrasound is appropriate for diagnosis, monitoring care, and/or intraarticular injections. Second, I am concerned that I will be tempted to aggressively treat small erosions or mild synovitis that is of questionable clinical significance. How should we decide when it is appropriate to use ultrasound? Is it ethical to buy a piece of technology as a means of generating revenue? And, finally, I understand that the learning curve is pretty steep. How will I know that I or my partners are adequately trained in ultrasound use?
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Dr. Meltzer is assistant professor of medicine at Thomas Jefferson University in Philadelphia. Dr. MacKenzie is associate professor of clinical medicine and public health at Weill Cornell Medical College, Hospital for Special Surgery in New York. Dr. Kitsis is director of bioethics education and a member of the rheumatology division at Albert Einstein College Medicine in the Bronx, N.Y.
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Letters from Our Readers
We received a few letters in response to the May 2011 Ethics Forum, which asked the question: What is the rheumatologist’s ongoing obligation to care for patients who do not have health insurance or other means to pay for their care? We wish to thank Drs. Block and MacGuire for their thoughtful responses. Especially in today’s climate, it is refreshing to hear from our colleagues who try to provide care for the less fortunate. Keep those letters coming!
Beyond the Bottom Line
The practice of medicine, despite the best efforts of government and industry, still remains more than just a business with a bottom line—at least I hope so.