Conflict of interest
A conflict of interest situation arises when the personal interest of a doctor is in conflict with the interests of his patients or the organisation he works for. It will lead to divided loyalty and, in its most serious form, can result in corruption or other criminal offence. Whether the conflict of interest is actual or perceived, the consequences can be grave. The integrity of the doctor's professional judgement may be compromised, patients may suffer from severe harm and, the trust in the individual doctor and in the medical profession as a whole will be impaired.
Scenario 1 | Referral of patient to professional treatment
Dr J is an orthopaedic surgeon of a public hospital. He saw that there was a huge demand for physiotherapy services in his hospital and patients have to wait for almost a year to receive such services. James, a relative of Dr J, is an experienced physiotherapist who operates a physiotherapy centre. Recently, some patients told Dr J that they didn’t want to wait too long for the physiotherapy treatment and thus asked if Dr J could refer them to private centres. Should Dr J refer the patient to James' centre? What if James invites Dr J to invest in the physiotherapy centre?
This is a conflict of interest situation for Dr J, a public doctor, to refer his patients to receive private medical treatment from his relatives.
Dr J shall follow the guidelines of the Hospital Authority (HA) in patient referral which specifies the restrictions on HA's doctors to refer patients to receive medical services at private medical practitioners. If Dr J refers the patient to James' centre, he might violate HA's "General Guidelines on Referring Patients for Private Healthcare Services", HAHO Operations Circular No. 25/2021, as it specifies that HA staff should not recommend specific private healthcare provider to patients.
HA's doctors and staff members should refrain from acquiring any investment that may lead to a conflict of interest situation. Doctors and staff members concerned are obliged to declare their own or their relation's investments to the HA if they perceive that such investments would conflict with their official duties.
It will be a serious misconduct if Dr J, a public officer by virtue of his position in HA, invests and conceals his financial interest in the physiotherapy centre from HA and refers his patient to receive medical services thereat. Under the common law offence of Misconduct in Public Office (MIPO), it will be an offence if a public officer wilfully misconducts himself in relation to his public office where such misconduct is serious having regard to the responsibilities of the office. Dr J might be liable to prosecution for a MIPO offence in this case.
On the other hand, the Code of Professional Conduct of the MCHK (Oct 2022) specifies that a doctor is required to take into consideration the best medical interests of the patient when referring him to other institutions. Doctors proposing to refer a patient to an institution in which they have a financial interest, whether by reason of a capital investment or a remunerative position, should always disclose the interest to the patient before making the referral. If a doctor has any interest in commercial organisations (including but not limited to organisations providing health care or pharmaceutical or biomedical companies) or products, he must not allow such interest to affect the way he prescribes for, treats or refers patients.
Scenario 2 | Arranging medical services for family members
Dr K is a public doctor serving at an elderly health centre which provides medical services for those aged 65 or over. As Dr K is the only doctor at the centre, he on numerous occasions secretly arranged clinical specimens from his brothers and sisters who were all under the age of 65 to be sent to the Clinical Pathology Laboratory for tests. Did Dr K violate any laws or regulations?
Dr K had dishonestly arranged free testing services for ineligible patients by deceptive means and thus he is liable to prosecution.
As a public officer, Dr K might also have committed the common law offence of Misconduct in Public Office (MIPO) for having abused his official position to arrange free medical services for his relatives who were ineligible persons. Under the MIPO, it will be an offence if a public officer who wilfully misconducts himself in relation to his public office where such misconduct is serious having regard to the responsibilities of the office. In this case, although no acceptance of advantages was involved, Dr K had misused his official capacity to misappropriate public resources for his family members. Such act of favouritism by Dr K was regarded as a conflict of interest of serious nature.
Dr K might also violate Section 9(3) of the Prevention of Bribery Ordinance if he had submitted service request forms for his family members containing false information regarding their age with an intent to deceive his employer, i.e. the government.
In any case, Dr K is subject to disciplinary action for violating internal guidelines of his employer, i.e. the government, as he had misused his position to benefit his family members.
At all times in the course of clinical practice, doctors should be prudent and abstain from engaging in actions that may lead to actual or perceived conflicts of interest. If a conflict of interest occurs, doctors should promptly declare it to the organisation they are working for and, in some circumstances, to their patients as well. Such situations include:
- any private interest which may affect their judgement in the discharge of their official duties;
- any investment held by themselves or their close relatives which may lead to conflict of interest situations; or
- any decision made which may ultimately prejudice the interests of other stakeholders such as patients and clients of their organisations.
