Amway

Timothy B. McCall, M.D.

We're hearing a lot about how managed care affects patients. But Marketplace medical commentator Dr. Timothy McCall says managed care is also changing doctors and the doctor-patient relationship.

When doctors get to talking with each other about managed care, they complain about the paperwork, the loss of autonomy, the drop in income. But there's one word that demonstrates just how worried they really are: Amway.

That's right, Amway. Although precise numbers aren't available, there's evidence that thousands of doctors are selling Amway products right out of their offices to boost their flagging, managed care incomes --you know, soap, car wax, vitamins, pots and pans.

Physicians involved with Amway appear to be concentrated in the South and Midwest. Plastic surgeons are reportedly among the most eager. Their income in some cases has dropped by half because of managed care.

You've got to wonder, though, what effect this has on the doctor-patient relationship. Just how are you supposed to feel when your doctor recommends a fantastic floor wax between examining your thyroid gland and listening to your lungs? What happens if you don't buy the goods?

The doctor-patient relationship is already under assault from managed care. Many people have had to switch doctors and may not know their new ones well. Office visits are invariably rushed and people have become more suspicious of their physicians' motives given financial incentives to keep patients out of the hospital, the emergency room and the specialist's office.

Perhaps mindful of this, the American Medical Association's Council on Ethical and Judicial Affairs recently came out against doctors' selling products from their offices, charging that it gives the public the impression that doctors are just "entrepreneurs trying to increase their income[s.]"

But Amway isn't the problem. It's a symptom. The underlying disease is the transformation of the doctor-patient relationship from healing convenant to just another business arrangement.

As our society prepares to debate the future of health care, we've got to ask ourselves what we really want. Are we willing to accept a system in which the doctor says no, he can't approve a referral to a dermatologist but he can sell you a really great skin cream?

Mental Health Care Coverage in HMOs

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