Most of us retail things to our patients. We sell such items as herbs, supplements, homeopathics, tea, books, magnets, plasters, massage tools, healthy cleaning supplies, liniments, soap and aromatherapy products.Some of us even sell multi-level marketed (MLM) products to our patients (personally I avoid the MLM thing). In a course I took with Marilyn Allen and Honora Wolfe a few years back, they said that the practice income should come from three sources or more: clinical treatments, selling things, and collecting rent or teaching, etc. They said that a stool has to have at least three legs to stand and be stable. I have heard exactly the same idea at a chiropractic seminar.
We sell the things we do, largely because the things we recommend are not available many other places. Especially the herbs, though I have seen a pharmacy Boulder, Colo., that stocks quite a lot of Chinese patents. Here at home, however, I have to make those things available to my patients because they are not sold anywhere else. Because I prefer to do custom herb formulation, I have a granular and crude herb pharmacy. My patients have no option other than to purchase from me.
Thirty or so years ago, I heard somewhere that it was unethical for medical doctors to own a pharmacy because they might be tempted to prescribe things in a different way than if they were not selling them. More clearly, the doctors might tend to recommend more medicine than they really needed to, in order to sell more and profit more. Or, they might prescribe medications they had in stock, rather than what was really best for the patient. My father, who was a physician, refused to take drug company perks due to his concern about this type of thing.
Nowadays, we have a medical doctor in our area who has a pharmacy in his building. Somehow I doubt that he is not financially profiting from that. We even have a bunch of surgeons who built their own outpatient surgical center, and have drained a local hospital of surgical cases; the OR is laying off nurses. We have the "dermaspa," where the dermatologist offers facials and sells special skin care products to patients. For top dollar, I must add. This type of thing alarms me. Is it ethical for surgeons to build their own surgical center so they can profit from not only performing the surgery but also from the business of the surgical center? Is it ethical for a physician to sell medications from his office? It seems that these days the answer is: no problem.
My aunt, who was a rural general practice physician in a town of fewer than 100 people, sold drugs right out of her office. This was back in the '60s and '70s. She had quite a lot of drugs there, but mostly just the basics. As the nearest pharmacy was 30 miles away, her patients really appreciated it. I assume that she profited by the selling of those medicines. But she was one of those country doctors who got paid in chickens, if at all. She probably gave away a lot of drugs. And she died very poor.
The issue here, though I doubt I need to point it out, is: might we be perceived as recommending to people the things we sell as a way to gain more profit? In the Iowa law regarding mental health services, it states that the clinician should not make client recommendations based on their own financial self-interest. Would someone get the impression that we see patients as needing the things we have in stock, not just because they really need that thing but because we want to move inventory? Might our recommendations be influenced by our ever-so-subtle desire to increase our personal gain? If we recommend something to a patient and they wish not to purchase it, does it make them uncomfortable to say "no" to our suggestion? Are they going to feel awkward about doing so, and perhaps leave our practice because they felt pressured to buy?
I know that the majority of acupuncturists are ethical caring people, who truly want to help patients and spread the good news of natural health methods. But I have found, over the years, that I tend to avoid recommending that people take herbs unless I think they are absolutely necessary, because I am afraid of being seen as trying to increase my profits by selling things. I also dislike putting my clients in a position where they might have to say "no" to my suggestion. I have had the general policy that people must ask about herbs or supplements before I will discuss it with them, except in the cases where Chinese herbs are the only thing that can do the job.
This may also be another arm of my wishing to avoid appearing to be a snake-oil salesman. Maybe this is because my father was a doctor. Maybe this is because I started my practice when acupuncture was still really new in my community and I wanted to appear very trustworthy. Or maybe just because I was aware that it had been thought of as unethical for physicians to sell medications to their patients in the past.
However, just about every chiropractor I have known sells something in their office. Exercise equipment, supplements and more. I don't think people generally see that as unethical. I believe that patients of chiropractors appreciate the fact that quality supplements and other health-related items are being made available by the doctor because the things they sell are provided to enable patients to get even more out of the treatment. People see chiropractors as financially successful. I think they like purchasing things there because they trust the judgment of the chiropractor, appreciate having access to the special things they offer, and like participating in the success.
I have often felt that the people who come to me are seeking acupuncture with needles, and they often seem overwhelmed and hesitant when I present the importance of using herbs in their treatment. They are sometimes more willing to use supplements until they get to know me and trust me more. The few people that I do treat with herbs often have such poor diet and lifestyle habits that the herbs seem not to work well. Additionally, in my busy acupuncture practice, I find it hard to suddenly stop and write a formula for a patient without some study. I am not satisfied with just throwing some brown BBs at them and hoping for the best.
So, I have found that I am not very comfortable selling to patients. I find it stressful, both ethically and time-wise. However, I still stock a lot of things in the clinic. I hope that I will find it easier over time to sell. Hopefully, I can feel clear someday that my desire to sell is not too heavily weighted in favor of my own financial benefit.
Click here for previous articles by Laura Christensen, MA, LAc, MAc.