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Private practice is unethical—and doctors should give it up

BMJ 2015; 350 doi: (Published 05 May 2015) Cite this as: BMJ 2015;350:h2299
  1. John Dean, consultant cardiologist, Royal Devon and Exeter NHS Foundation Trust Hospital, Exeter EX2 5DS
  1. lub.dub{at}

Profit rather than need is a poor driver of clinical decision making, writes John Dean. Private practice also directly affects the care that NHS patients receive, he says—which is why he’s stopped doing it

Ask any smoker: the last person they want to be with when lighting up is someone who has just quit. I sense a similar discomfort among some of my colleagues now that I have given up private medical practice. Like a lapsed Catholic shunned by the priesthood, I have become an apostate.

I have always been ambivalent about private practice, and I had become increasingly uncomfortable about my own involvement. I realised that, in all conscience, I could not go on with it. No matter how high I set my own moral and ethical standards I could not escape the fact that I was involved in a business where the conduct of some was so venal, it bordered on criminal—the greedy preying on the needy.

The business of medicine and the practice of medicine are at odds. Private medicine encourages doctors to make decisions on the basis of profit …

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