Department of Anatomic and Clinical Pathology and Laboratory Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue/L25, Cleveland, OH 44195, USA.
Clin Dermatol. 2012 Sep-Oct;30(5):476-81. doi: 10.1016/j.clindermatol.2011.06.015.
Some of the most contentious and relevant ethical issues in dermatopathology include client billing, the practice of dermatopathology by physicians without board certification in dermatopathology, and the practice of including recommendations regarding further surgery in dermatopathology reports. Client billing is a system in which clinicians directly compensate laboratories for pathology services and directly bill patients and/or third-party payers. Although proponents argue that this system can reduce health care costs and increase efficiency, others have argued that it creates an environment that fosters unethical, and potentially illegal, behavior. The development of various types of laboratory models, commonly referred to as "contractual joint ventures," has served to expand client billing. Although the field of dermatopathology is considered a subspecialty of both clinical dermatology and anatomic pathology, dermatopathology is commonly practiced by clinical dermatologists and general anatomic pathologists who are not board certified in dermatopathology. Although these physicians are legally entitled to practice dermatopathology, some have questioned the ethics of this situation, especially when board-certified dermatopathologists are available. Finally, dermatopathology reports, on occasion, include suggestions regarding the need for additional surgery or other clinical courses of action. Although established guidelines do not fully endorse or discourage this practice, various opinions exist regarding its affect on patient care.
皮肤科病理学中一些最具争议和相关的伦理问题包括客户计费、非皮肤科病理学委员会认证的医生从事皮肤科病理学实践，以及在皮肤科病理学报告中包含有关进一步手术建议的做法。客户计费是一种临床医生直接向实验室支付病理学服务费用，并直接向患者和/或第三方付款人计费的系统。尽管支持者认为该系统可以降低医疗保健成本并提高效率，但也有人认为它创造了一个助长不道德甚至潜在非法行为的环境。各种类型的实验室模式的发展，通常被称为“合同合资企业”，已经扩大了客户计费。尽管皮肤科病理学被认为是临床皮肤病学和解剖病理学的一个亚专科，但皮肤科病理学通常由未获得皮肤科病理学委员会认证的临床皮肤科医生和普通解剖病理学家实践。尽管这些医生在法律上有权从事皮肤科病理学工作，但有人质疑这种情况的伦理道德，尤其是在有认证的皮肤科病理学家的情况下。最后，皮肤科病理学报告有时会包含有关需要进一步手术或其他临床治疗方案的建议。尽管有既定的指南不充分支持或不鼓励这种做法，但对于其对患者护理的影响存在各种意见。
