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After reflecting and reading responses to Dean's personal view, I have mellowed towards a colleague whose genuine concerns about private practice and his ability to maintain his own personal standards in such a system are injudiciously portrayed as almost an admission of professional guilt. 1 This article was used more broadly as part of The BMJ's agenda, which seeks to attack any enterprise in medicine and anything that might deviate from the NHS.

Profit rather than need is a poor driver of clinical decision making and undoubtedly there is a potential conflict when charging a fee for medical or surgical services. 1 I have therefore set myself the \"NHS test\" in my private practice: would I offer the same advice and treatment if I were seeing the same patient in the NHS?

The doctors who work in this practice are all licensed by the GMC and are assessed using the appraisal programme of the Independent Doctors Federation, which is robust and rigorously audited and validated.

[...]a common argument is that having a private practice in tandem with NHS responsibilities has a positive benefit for the latter.

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

Private providers in the UK rely largely on medical staff trained and employed by the NHS and bear few of the statutory or whole system overheads of the NHS.

In the past, several researchers in the field of physiotherapy have asserted that physiotherapy clinicians rarely use ethical knowledge to solve ethical issues raised by their practice. Does this assertion still hold true? Do the theoretical frameworks used by researchers and clinicians allow them to analyze thoroughly the ethical issues they encounter in their everyday practice? In our quest for answers, we conducted a literature review and analyzed the ethical theoretical frameworks used by physiotherapy researchers and clinicians to discuss the ethical issues raised by private physiotherapy practice. Our final analysis corpus consisted of thirty-nine texts. Our main finding is that researchers and clinicians in physiotherapy rarely use ethical knowledge to analyze the ethical issues raised in their practice and that gaps exist in the theoretical frameworks currently used to analyze these issues. Consequently, we developed, for ethical analysis, a four-part prism which we have called the Quadripartite Ethical Tool (QET). This tool can be incorporated into existing theoretical frameworks to enable professionals to integrate ethical knowledge into their ethical analyses. The innovative particularity of the QET is that it encompasses three ethical theories (utilitarism, deontologism, and virtue ethics) and axiological ontology (professional values) and also draws on both deductive and inductive approaches. It is our hope that this new tool will help researchers and clinicians integrate ethical knowledge into their analysis of ethical issues and contribute to fostering ethical analyses that are grounded in relevant philosophical and axiological foundations.

[...]he had printed prescriptions already prepared by PI reps, for those persons who were found to have HCV infection. Since margins for pharmaceutical companies were huge, they were earning profits at a price even below the MRP. Only two of seven deaths over 45 years in HCV group were due to liver disease.8 I have often talked to him about published natural history, 'SD, do you advise treatment to all those found positive or do you select patients with high risk for disease progression?' Both of us know that factors that increase the risk of progression of fibrosis in HCV infection include alcohol intake, an older age at infection, male sex and coinfection with other viruses. Misconduct 7.11 A physician should not contribute to the lay press articles and give interviews regarding diseases and treatments which may have the effect of advertising himself or soliciting practices; but is open to write to the lay press under his own name on matters of public health, hygienic living or to deliver public lectures, give talks on the radio/TV/internet chat for the same purpose and send announcement of the same to lay press. 7.12 An institution run by a physician for a particular purpose such as a maternity home, nursing home, private hospital, rehabilitation centre or any type of training institution etc. may be advertised in the lay press, but such advertisements should not contain anything more than the name of the institution, type of patients admitted, type of training and other facilities offered and the fees. 7.13 It is improper for a physician to use an unusually large sign board and write on it anything other than his name, qualifications obtained from a University or a statutory body, titles and name of his speciality, registration number including the name of the State Medical Council under which registered.

Recently, I read about two New York City physicians who have started a concierge primary care practice where patients \"come for the stress test and stay for the collagen.\"1 Although some features of the practice seemed laudable - being more avail- able to patients - others struck a nerve. The physicians plan to take \"a compre- hensive, methodical approach to life extension,\" and one founding physician \"envisions administering state-of-the-art screenings that use biochemical markers to identify potential predictors of can- cer.\" It all sounded fishy to me, so I posted the article on Facebook, with a single word: \"Shameful.\" By the end of the day, there were crit- ics. A fellow physician demanded to know, \"Why is this shameful?\" He argued that people should be free to pay for whatever they want as long as it does not affect the rest of us. I rallied, arguing that when unnecessary testing detects abnormalities, the downstream tests and procedures are often covered by insur- ance, which does affect the rest of us. Others came to my defence. There is no cure for aging, a colleague argued, and bo utique pra ctices that promo te unproven remedies undermine the pub- lic's trust in physicians. Yet another doc- tor drew analogies to the personalized care Michael Jackson received, and a physician friend noted that not being able to see why this is shameful is itself shameful. Several oth ers showered \"likes\" on some, any or all of these com- ments, and I couldn't help but see this as the future of community discourse.

Background In the course of the last four decades, the profession of physiotherapy has progressively expanded its scope of responsibility and its focus on professional autonomy and evidence-based clinical practice. To preserve professional autonomy, it is crucial for the physiotherapy profession to meet society's expectations and demands of professional competence as well as ethical competence. Since it is becoming increasingly popular to choose a carrier in private practice in Denmark this context constitutes the frame of this study. Physiotherapy in private practice involves mainly a meeting between two partners: the physiotherapist and the patient. In the meeting, power asymmetry between the two partners is a condition that the physiotherapist has to handle. The aim of this study was to explore whether ethical issues rise during the first physiotherapy session discussed from the perspective of the physiotherapists in private practice. Methods A qualitative approach was chosen and semi-structured interviews with 21 physiotherapists were carried out twice and analysed by using a phenomenological framework. Results Four descriptive themes emerged: general reflections on ethics in physiotherapy; the importance of the first physiotherapy session; the influence of the clinical environment on the first session and; reflections and actions upon beneficence towards the patient within the first session. The results show that the first session and the clinical context in private practice are essential from an ethical perspective. Conclusions Ethical issues do occur within the first session, the consciousness about ethical issues differs in Danish physiotherapy private practice, and reflections and acts are to a lesser extent based on awareness of ethical theories, principles and ethical guidelines. Beneficence towards the patient is a fundamental aspect of the physiotherapists' understanding of the first session. However, if the physiotherapist lacks a deeper ethical awareness, the physiotherapist may reason and/or act ethically to a varying extent: only an ethically conscious physiotherapist will know when he or she reflects and acts ethically. Further exploration of ethical issues in private practice is recommendable, and as management policy is deeply embedded within the Danish public sector there are reasons to explore public contexts of physiotherapy as well.