According to Dale Buchbinder in his book, Cases in Healthcare Management, the following case study is presented for your consideration:

You are the new Practice Manager of a busy medicine practice. There are five physicians in this practice. They see patients four days a week using a myriad of exam rooms, plus each physician has his/her own consultation room. On most days, three of the physicians are seeing patient in the office while the other two are doing hospital work and minor procedures. You have noticed that every Tuesday and Thursday various pharmaceutical representative provide lunch for free to the office. The lunches are sometime quite elaborate, with filet mignon and crab cakes, and at other times more mundane, with cold cuts or pizza. These lunches are quite regular, and there is always enough food to feed no only the physicians, but also the entire staff.

Recently two of the representatives have come to you complaining that even though they provide a substantial lunch a couple time a month, the use of their products has decreased by the doctors in the practice. The representatives inform you if this continues they may not be able to continue the practice of providing lunch. When your support staff member hear of this, they become somewhat concerned because they enjoy the fact that they are getting a free lunch several times a week. On the other hand, physicians rarely participate in lunch, do not know when and who is providing the lunch, and often they are too busy to participate in lunch.

You set up a meeting with the physicians to discuss the problem. In the meeting you tell the physicians that the staff looks forward to the free lunches. They feel it is a benefit with the job and would like the lunches to continue. Three of the physicians are unsympathetic to this problem and state they believe the lunches are probably a conflict of interest. These physicians point out the lunches are not tied to any educational endeavor and recommend stopping the lunches, effective immediately. The other two physicians are not adamant, but state these lunches are important to them. Bottom line, you are given a clear message by the physicians that this practice is to stop.

You know the pharmaceutical representative usually contact the staff members, not you, to set up these lunches. Right after the meeting with the physicians, you inform everyone on your staff verbally and in writing that these luncheons are not to be scheduled in the office anymore. You take great care to explain this practice is inherently a conflict of interest, charged with legal and ethical issues that could jeopardize the integrity of the practice. Thus, there can be no more free lunches. The entire staff is in an uproar, disgruntled and unhappy about the decision.

Questions:

What are the three factors contributing to this dilemma?

Are there any situations where pharmaceutical representatives can bring food to the offices of practicing doctors without it being a conflict of interest?