Ethics considerations of weight management and nutrition counseling services

In a time of declining reimbursements and increasing regulatory headaches, ancillary services can be enticing with the promise of new revenue streams. But ethical considerations should guide any practice decisions.

Physicians are operating in a climate of economic constraint, struggling to survive in the primary care arena, says David Fleming, MD, FACP, chairman of the American College of Physicians Ethics, Professionalism, and Human Rights Committee.

The ethical dilemma occurs, he says, when a physician crosses over from a primary concern for the welfare of patients and makes decisions based on serving their own economic needs. A physician who is truly in service orientation offers weight management and nutrition counseling services that are evidence-based. That physician also might stock products not readily available elsewhere for patients, charging only enough to cover overhead, product costs, and associated businesses costs.

When physicians start providing nutrition and other kinds of products out of the office to supplement income, the focus can move from serving the patient to serving the physician’s bottom line. When a family practice begins operating as a retail store in competition with a for-profit business, that can be a problem, because it leads to the temptation to market that product, which has a direct influence on the practice and the patients, Fleming says.

“We’re all providing nutritional and weight loss services through the care of patients. The standard of care is to advise patents on a healthy lifestyle, offer professional services that are evidence-based and enable the maximum opportunity for success,” Fleming says. “But to lay on top of that a retail process, whereby you’re charging in addition to that for products that may or may not be effective, you’re practicing retail.”