From the Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD (Xu, Jain).
Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Humbyrd).
J Am Coll Surg. 2022 Sep 1;235(3):539-543. doi: 10.1097/XCS.0000000000000271. Epub 2022 Aug 10.
As surgical care continues to transition to an outpatient setting, ambulatory surgery centers (ASCs) present favorable options for physician investment. As of 2017, more than 90% of ASCs have at least some physician ownership, with 64% solely physician-owned. Yet, physician ownership creates an inherent conflict of interest known as dual agency, where clinicians have a personal financial stake in addition to their obligation towards patient well-being. Here, we assess the ethical considerations surrounding dual agency in the setting of ASCs through the lens of beneficence, nonmaleficence, autonomy, and justice. We further propose strategies for appropriate navigation of such situations, including disclosure of ownership status, instruction on unfamiliar techniques, and adherence to accepted clinical practice guidelines for materials selection and surgical indications.
随着外科护理不断向门诊环境转移，日间手术中心 (ASC) 为医生投资提供了有利选择。截至 2017 年，超过 90%的 ASC 至少有部分医生所有权，其中 64%为纯医生所有。然而，医生所有权会产生一种内在的利益冲突，即双重代理，临床医生除了对患者的健康负责外，还有个人的经济利益。在这里，我们通过有利、不伤害、自主和公正的角度来评估 ASC 环境中双重代理的伦理考虑。我们还进一步提出了适当处理这种情况的策略，包括披露所有权状况、指导不熟悉的技术以及遵守材料选择和手术适应证的公认临床实践指南。
