Chapter 7: Conflicts of Interest
The Definition of "Conflict of Interest"
A conflict of interest is essentially anything that could affect your impartiality in the performance of your work, or tempt you to compromise your professional ethics. If something that could benefit you in some way has the potential to affect your professional judgment, and cause you to choose an improper course of action over an appropriate one, that is a conflict of interest.
SCENARIO:
You work as an MLT in a rural hospital, covering multiple disciplines and diverse procedures, including blood collection. A friend has just completed a course in alternative medicine and is starting up her own clinic. She offers to pay you ten dollars for each contact with test results outside the normal range, whatever the test. You need not provide anything other than the patient’s name, and either an address or a phone number; she will do the cold calling. This is easy money and you’re not being asked to divulge any test results so you accept the offer. Is this a conflict of interest?
Your employer likely has a strict policy against arrangements of this type. In this scenario, your duty to keep personal information confidential conflicts with your objective of finding new patients for the clinic. A personal interest such as this is a conflict of interest if it requires you to share information that you, as an MLT, have access to, with a third party who does not have the right to access that information. Though you may not be sharing test results, you are sharing people’s names and contact information, and the information that they had an encounter with the health care system that resulted in an abnormal finding.
This scenario—helping a friend find clients—might not be a conflict of interest if it was clear that the information used to find clients for the clinic did not come from your employment as an MLT. Importantly, however, in assessing the possibility of a conflict of interest, one does not have to ask whether impartiality was affected, or whether professional ethics were compromised: one only has to ask whether it appears possible.
SCENARIO:
You realize that it’s wrong to provide your friend at the alternative medicine clinic with client information and you decline her offer. Instead, you offer to talk up the clinic with patients while you are collecting blood. You keep a couple of her business cards in your lab coat pocket just in case someone should ask for more information. This way, the patient will be approaching the clinic and providing personal information voluntarily. Is this still a conflict of interest?
Several aspects of this scenario are troublesome. First, if you recommend your friend’s clinic while working in a professional capacity as an MLT, it’s reasonable to assume that you endorse the clinic, and patients may even assume that your employer does so. In actual fact, you’re recommending the clinic because you want to help your friend; it’s a personal interest. Secondly, you have a duty to avoid suggesting anything that could potentially cause harm to a patient, and in this situation you can’t be sure. It’s still a conflict of interest.
Variations on Conflict of Interest
As we saw in the scenarios above, conflicts of interest come in many different forms. It’s helpful to consider what other people will think, the CSMLS Code of Professional Conduct, and employer policy when considering any suspect action. The Code states that “The welfare of the patient and respect for the dignity of the individual shall be paramount at all times.” This means that what’s best for the patient always comes first, to the best of your ability, and it can be a useful resource for good judgment.
There are various potential situations where you might be tempted to put someone other than the patient/client first (usually yourself, but not always):
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Using personal status or influence: The previous example— recommending an alternative medicine clinic while working as an MLT—highlights the impropriety of using your position or influence for personal gain—even if the gain is as insignificant as helping out a friend. Other scenarios might include selling a product outside the workplace using your professional credentials (likely also professional misconduct for other reasons). Never use your credentials to endorse anything outside your scope of practice for personal gain.
The temptation to slip a lab test through for oneself or for a friend or relative, another example of using personal status, is common for MLTs. This is a conflict of interest in that you are using your position as a technologist in the lab to confer or receive a benefit. Though you might argue that the patient benefits, the client (in this case, the employer), is harmed because you’ve used unauthorized time and resources. Of course, this scenario is also professional misconduct on several levels. - Conferring a benefit: In our scenario above, referring people to your friend’s clinic would be conferring a benefit. In another example, if you’re in a position to influence the decision about product purchases, and you happen to be friends with a particular sales representative, you might be tempted to help him or her out by purchasing products. This would be a conflict of interest because you would be conferring a benefit on your friend instead of purchasing the product that would be best for your application. In any case where you have a dual relationship such as this, you have a potential conflict of interest.
- Receiving a benefit: Similarly, taking money for patient contact information is receiving a benefit. And if you accept something from a sales representative in return for a product order, you will be receiving a benefit, and in a conflict of interest situation. The benefit could be virtually anything from a box of chocolates, or tickets to next week’s hockey game, to something of much greater value; if it is significant enough to tempt you to return a favor, it is too much.
- Selling products for profit: There are other ways you might gain inappropriately through your work as an MLT. For example, if you have direct patient contact, you should not try to sell any additional products that aren’t directly connected to your professional contact with them. If you were to sell a health care product for personal profit, for example, the client might assume an endorsement by your employer or company, or fail to understand that your motive is personal profit rather than their health care needs. Also, no selling chocolate bars for your child’s fundraiser, or tickets to see your brother’s band! While these things might appear harmless, your client might worry that your interaction will be affected if he or she declines.
- Using a client’s personal belongings: Virtually any interaction between you and a client that goes beyond your professional duties creates a potential conflict of interest. Use of personal items such as a cell phone, or computer, or even sharing tea and cookies, raises the possibility that you are receiving a benefit for something offered, or taking unprofessional advantage of your position.
- Incentives: Many businesses offer incentives such as coupons or free products in exchange for purchases. While this is common in retail business, it should be approached with caution in health care. An incentive mustn’t risk the client’s care or health care decisions. Free (or even discounted) home use medical test kits, for example, might influence a client to defer or cancel a medical appointment.
- Personal beliefs or convictions: Another type of conflict of interest that is less obvious has to do with personal convictions. Treating a client or sample differently because of a religious or moral belief, or any other strong conviction is a conflict of interest. This could be anything from setting a specimen aside “for later” because you know it contains products of abortion, to bending employer protocol to rush through a test on a war veteran. In these cases, your personal opinions on the moral permissibility of abortion, or the respect due to those who have served their country, are irrelevant.
Dealing With Conflicts of Interest
The first step in dealing with conflicts of interest is recognizing when they occur.
Is there a conflict of interest? If you’ve unsure, try following these steps:
- Ask yourself who benefits. If the patient or client does not benefit, but you do, you likely have a conflict of interest. If both of you benefit, there might still be a problem.
- Consider whether you would be comfortable if others knew about the arrangement— colleagues, friends, family. If you wouldn’t want them to know, you likely have a conflict of interest.
- Consult the Code of Professional Conduct and your employer’s policy. Is there anything there to prohibit the scenario you’re considering?
- Ask colleagues or the College for a professional opinion about whether you have a conflict of interest.
If you conclude that you have a conflict of interest, you might be able to manage it, using what is called the DORM principle: disclosure, options, reassurance, modifications. Depending on the circumstances, you may not need to use all four measures to manage your conflict of interest.
Disclosure: Be open and honest with all interested parties. Acknowledge the possible conflict of interest with the client, anyone who stands to gain, your employer, perhaps even the College. Transparency now can avoid uncomfortable questions later.
Options: If the conflict of interest involves something you are recommending or offering to someone (with your employer’s approval, of course) be careful to offer them alternatives. For example, if you were giving a presentation about a new piece of lab equipment, and the sales representative has taken you out to lunch several times to discuss it, be sure to devote appropriate time to similar equipment on the market, with an objective approach to any comparison.
Reassurance: Make sure that people feel completely free to make their own decisions without repercussions. In a situation where someone may potentially feel pressured to do something that would benefit you, offer reassurance that a refusal will not affect your relationship with them in any way.
Modifications: Perhaps you can change the scenario to remove the conflict of interest. If a sales representative gives you a box of chocolates, share it with your co-workers. A more expensive gift might be donated as a prize or a gift to charity (Note that this course of action still benefits you in that you enjoy the pleasure of giving it away, and the admiration of your peers; however, if it removes the perception of conflict of interest, then it likely makes that conflict of interest negligible.)
Conflicts of Interest That Must Be Avoided
Obviously, some conflicts of interest can never be managed and must be avoided entirely. Among these are anything that is illegal, anything that goes against the Code of Professional Conduct, and anything that your employment contract forbids.
Above all, be ethical. If you are dealing with a vulnerable client, such as a very ill or elderly person, your reassurances may not be enough to set him or her at ease, and will not negate the conflict of interest. Similarly, if the sales representative goes beyond chocolate and free lunch to send you on an all-expenses-paid cruise of the Greek islands, no one will be convinced by your attempts at disclosure or pointing out options.
Remember that it is the appearance of a conflict of interest that counts: your intentions and actions may be entirely honorable, but if others perceive that you have a conflict of interest, then you have one.
Conclusion
The potential for conflicts of interest is always present in our professional lives, if only because professional practice tends to overlap with personal lives. Situations that compromise our judgment can be stealthy and difficult to recognize; however, the inner voice that tells you when something is just not right is a good guide for knowing when you need to change something or avoid it. Other valuable resources include colleagues, the NSCMLT, the CSMLS Code of Professional Conduct and your employer.
