Kickbacks and self-referral
===========================

* George Southey

Sujit Choudhry and associates1 raise some excellent points in their discussion of the unethical nature of physician kickbacks and physician self-referral. An additional related behaviour is on the horizon for physicians in many provinces.

Electronic medical records and clinical management systems are now being promoted by federal and provincial authorities as a valuable component of care. One of the many functions currently being touted as desirable in a clinical management system is direct communication between the prescribing doctor and the patient's pharmacy for both new and repeat prescriptions. 

For the vast majority of prescribing physicians and pharmacists, the ability to send a prescription to a pharmacy “at the touch of a button” will be a welcome relief from repetitive, illegible, hand-written prescriptions. For a few doctors and pharmacists, this function will represent an opportunity for hidden financial gain (through a kickback).

Time could be well spent asking questions about direct connections between a prescribing physician and a pharmacy. Provincial regulating authorities for both pharmacists and physicians should examine the risks and benefits of this functionality. They should also determine what reporting and control mechanisms are needed to minimize the temptation of a destructive conflict of interest.

**George Southey** Lead Physician Dorval Medical Associations Family Health Network Oakville, Ont.

## Footnotes

*   *Competing interests:* None declared.

## Reference

1.  1. Choudhry S, Choudhry NK, Brown AD. Unregulated private markets for health care in Canada? Rules of professional misconduct, physician kickbacks and physician self-referral [editorial]. CMAJ 2004;170(7):1115-8.
    
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