Dr. Boggess (Medical Director)
Dr. Tony Boggess is a Physical Medicine and Rehabilitation (PM&R) physician, speaker, and writer who specializes in Nutritional and... read more
Concerns have been raised by the American Medical Association (AMA) about the growing number of physicians offering “fee-for-service” treatments and alternate approaches or products to pharmaceuticals in their medical offices. This letter is meant as a thoughtful rebuttal of the association’s opinions of complementary and alternative approaches and a clear outline of every patient’s rights and the physician’s responsibilities regarding these concerns.
Increasingly patients recognize the frustrations associated with illness-based medicine and seek preventative, holistic, and natural alternatives for their health care needs. And while conventional medicine has an excellent track record for addressing obvious disease and injury, it lacks effective tools to address pre-disease imbalances and vague symptomatology that clearly impacts quality of life for many patients. Likewise, multiple disease states have now been proven to respond to non-conventional interventions. Patients are increasingly voicing interest in these approaches, and functional medicine physicians, such as myself, find it rewarding to work with patients at this level.
Nevertheless, what the AMA remains concerned about is the potential for abuses. This holds true for conventional and non-conventional medicine alike. The responsibility to make ethical decisions remains high for all medical practitioners and consumers and patients should be fully informed of their rights as described below.
Rights, Disclosures, & Responsibilities
- It is always the physician’s responsibility to describe all treatment options (including not to treat) for any condition or symptom
- All treatments require informed consent, and it is the physician’s responsibility to answer all questions to the patient’s satisfaction before proceeding.
- Less evidence exist supporting the use of alternative medicine and nutraceuticals “supplements” as compared to standard procedures and pharmaceuticals “drugs.” (Although, the medical literature is growing in this area and we follow it closely).
- You are never required to purchase supplements or other products from our office. We offer the products we recommend below retail value for your convenience.
- You are never required to undergo treatments that are considered “alternate strategies” for any reason, and you always have a right to second opinion.
- The practice derives income for the sale of all products, supplements, and books in our office, disclosed at the time of purchase.
Rational for providing products in our office
- Quality: Nutraceuticals/supplements are not regulated like drugs, and there are differences in potency, purity, and formulations. Knowing products are from an excellent source, we can better judge clinical outcomes based on observations and patient self-report rather than worrying about product quality.
- Availability: Some of the nutraceuticals we prescribe are not available from a single source or website. Before we began providing these products, our patients met with significant frustrations and compliance with our instructions was poor.
- Monitoring: It is difficult to keep track of all the nutraceuticals and medications that patients are taking. The task is simplified when most nutraceuticals are prescribed direct from our office.
- Treatment Options: Published scientific literature is not as widely available for nutraceuticals as for pharmaceuticals. Thus clinical experience becomes more important. If we are going to invest in products, we must have an expectation they will work well. Our practice reputation depends on the effectiveness of the nutraceutical products we recommend.
- Cost: Activities involving nutraceuticals, ordering, storing, book keeping, et cetera, comes with administrative costs and we tend to spend more time with patients answering questions about complex nutritional protocols. All this is not directly reimbursable under the insurance coding system. We could charge more for our office visits, but this would in turn result in higher out-of-pocket costs for our patients.
- Ethics: There is always a potential conflict of interest in the setting of patient care. Not only with drugs and supplements, but also with tests ordered, procedures performed, coordinating care with other agencies, referral relationships, continuing medical education perks, free lunches, et cetera. Therefore, clearly a potential conflict of interest exists for most of what physicians do (not just alternative care approaches). A functional medicine practice providing nutraceuticals to patients from its pharmacy is no different than an eye doctor providing glasses, or an ear doctor who sells hearing aids. (However, products offered as alternatives to drugs, impact pharmacy sales, and we are fully aware how disconcerting this is to the drug companies AND their partnerships with national, state, and specialty medical associations–It’s just the way it is unfortunately.)
- Bottom line: An ethical physician will keep the best interest of patients foremost in his or her mind and examine ALL outside influences and financial considerations. In the end it up to each individual physician to make the best decisions for our practices and patients and it is up to each individual patient to make informed decisions about the treatments they wish to undergo.