Current Concepts And Controversies With In-Office Dispensing
- Volume 21 - Issue 11 - November 2008
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While there are a variety of perceptions about the nature of in-office dispensing, this author addresses key issues and says it can be a valuable addition to one’s practice for physicians and patients.
One of the hottest debates in podiatric medicine involves the process of dispensing products to patients. Many feel that dispensing ancillary products provides patients with a plethora of value while opponents argue that dispensing is only a source of physician profit.
Products that are currently being dispensed by podiatrists include moisturizers, antifungal medications, shoes (both therapeutic and non-therapeutic), diabetic socks, nutrients and a variety of ankle-foot orthoses (AFOs) and braces.
Physicians who have been the early adopters of in-office dispensing will testify to the effect that it has on patient convenience, compliance and satisfaction. Physicians who are reluctant to embrace in-office dispensing may have certain perceptions about this practice. Accordingly, let us take a closer look at some of these key issues.
Does In-Office Dispensing Subvert Medical Professionalism?
The first point of controversy surrounds the issue of professionalism. Ideally, physicians are perceived as professionals in that they give advice and make decisions from a selfless perspective. The patient seeks this advice because he or she feels that the physician will put aside personal financial gain and treat the patient in the best manner possible. The sale of products dispensed in the office tests this premise.
The dispensing podiatrist may argue that the best product to improve the patient’s foot health can only be found in a product sold from his or her office. This means that the opportunity to purchase such a product can provide the patient with enhanced care and allows the physician to offer a valuable service. In addition, some proponents suggest that on-site purchases can save time and allow the patient to get a recommendation and product simultaneously. Accordingly, this would enhance both convenience and adherence.
However, other physicians contend that the practice may promote unprofessional or unethical conduct when a retail component is incorporated into a clinic setting. Certainly, there are two perspectives to this argument.
The key to finding the truth in this controversy is to analyze the value of products as well as a physician’s normal prescribing pattern prior to engaging in office dispensing. What products do you find valuable and what products are you currently recommending that patients obtain in the local pharmacy? Once one is engaged in dispensing products in the office setting, significant changes in this pattern might be subject to scrutiny. Are you providing something important or merely a biased recommendation? This is the key ethical question that all dispensing physicians must critically ask themselves.
The second point of controversy is the efficacy of products dispensed in the office. It is a physician’s obligation to be certain that recommended products have an evidence-based nature to their efficacy. Those skeptical about in-office dispensing often associate the practice with “snake oil salesmen” tactics. Physicians can often nullify this argument with a product’s documented efficacy.
Is it possible to be a physician and businessperson? On this point of controversy, I have a passionate opinion. Long gone are the days when a physician can be successful at his or her craft without regard to business matters. Placing the pure business of in-office dispensing aside (cost of goods, revenue production, profitability, etc.), I firmly believe dispensing speaks to another important business virtue: total quality management.