Conflict of Interest in Healthcare – The Caring Generation®

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The Caring Generation® – Episode 52 August 19, 2020. On this caregiver radio program, Pamela D Wilson, caregiving expert shares examples of Conflict of Interest in Healthcare and explains what Leaving Against Medical Advice Means for elderly adults and their caregivers who might be worried about health. Dr. Sharmila Dissanaike, Chair of the Department of Surgery at Texas Tech University talks about the high expectations of consumers for the healthcare system and Preventing Burnout Among Physicians.

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Conflict of Interest in Health Care and Being Worried About Health


00:04 Announcer: Caregiving can sometimes feel like an impossible struggle. Caregivers may be torn between taking care of loved ones and trying to maintain balance in life. The good news is that it doesn’t have to be that way. The Caring Generation with host Pamela D. Wilson is here to focus on the conversation of caring. You’re not alone. In fact, you’re in exactly the right place to share stories and learn tips and resources to help you and your loved ones. So now, please welcome the host of The Caring Generation, Pamela D. Wilson.


00:47 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host on The Caring Generation radio program, coming to you live from the BBM Global Network, Channel 100, and TuneIn Radio. The Caring Generation focuses on conversations about health, well-being, caring for ourselves and loved ones, all tied together with humor and laughter, that are essential to being a caregiver. During this program, we will talk about conflict of interest in healthcare situations and leaving against medical advice. Caregivers express fear about the unknown, including fears about managing healthcare. If you’re worried about health—yours or an elderly parent—one solution that I always talk about is patient education and engagement. As we age, good health becomes more critical to having a quality of life that we enjoy. Yet, health isn’t something we talk about at birth, or even in our youth. There is little or no healthcare education in schools. It’s not until we begin experiencing healthcare problems that we take an interest in health, and some of us become more worried about health than others.

Why Patient Education is Important

02:00 Pamela D. Wilson: Waiting too long to see a doctor can result in having irreversible healthcare issues that are called chronic diseases:heart disease, diabetes, breathing issues. Having a doctor that you see regularly can really make all the difference. But what happens when physicians experience burnout? Our guest for the health and wellness segment of the program is Dr. Sharmila Dissanaike, Chair of the Department of Surgery at the Texas Tech University Health Science Center. Her clinical and research interests focus on trauma, burns, critical care, and emergency room surgery. She has received multiple awards for academic excellence, clinical performance, research, and teaching. She is a national leader in promoting better healthcare systems to prevent burnout among doctors who provide direct care to patients. Let’s start by talking about conflict of interest in healthcare.

03:03 Pamela D. Wilson: Conflict of interest in healthcare occurs when the primary goal of supporting the health of patients comes into conflict or disagreement with any other secondary goal. Like—for example—any type of personal gain to healthcare professionals or organizations. A focus on revenue, selling healthcare products or services over and above patient benefit. Consumers, patients, and the elderly are vulnerable populations because they’re worried about health. Professional conflict of interest, though, is not limited to the healthcare industry. You might see it in other places, like banking, financial services, counseling, attorneys, automobile dealerships, roofing companies, and other service providers who prey on vulnerable populations, many of which are elderly.

03:58 Pamela D. Wilson: Conflict of interest in healthcare can be a significant issue. Regulations have changed over the years to manage blatant conflict of interest in healthcare, although concerns still exist. Here are a few examples. A physical therapy clinic pays a nursing home a million dollars for referrals, for home therapy services, for clients who are discharged from that nursing home. In the past, pharmaceutical companies gave physicians trips, tickets to events, dinners at expensive restaurants. They delivered breakfast and lunch to their medical offices, all in return for promoting medications or medical products to their patients, to you. Doctors were paid speaking fees to promote products. Many of these concerns were addressed by the Sunshine Act. However, you must know that conflict of interest in healthcare and other areas still exists. If you work with healthcare organizations, it’s likely there are relationships that you don’t know about unless you ask. And know that it’s okay to ask. Never be embarrassed.

05:06 Pamela D. Wilson: One example of a conflict of interest in healthcare was discussed in The Caring Generation podcast called “What is Assisted Living?” You can look up this program. I talk about the relationships between assisted living communities and referral agencies, like A Place for Mom. If you are thinking about placing a loved one in a care community, this is a podcast that you want to look up, and listen to, and share. It’s important for you to know how money exchanges hands when you use any type of referral company or healthcare company. If you are involved in managing your health, or the health of an aging parent, it’s easy to be worried about health and everything that you have to do. A question that you want to start asking is, “Are there any conflicts of interest I should know about?” I guarantee you this. Healthcare providers will wonder why you’re asking the question. Half of them might have a blank stare on their face, because conflict of interest in healthcare may not be regularly discussed with their employees. Some of the employees may not even be aware of conflicts of interest.

06:15 Pamela D. Wilson: Anyone worried about health must be aware that self-interest exists. Here are a couple more general examples. You need an x-ray. Your doctor’s office gives you a map to the closest imaging center and the order for an x-ray. If you look into this, you might learn that your doctor’s office has a partnership with that imaging center. Here’s an example of this for SCL Health here in Denver. On their website is a partnership page that lists Touchstone Imaging. This page reads, “Recognizing the value of providing convenient, affordable outpatient imaging services, SCL Health is partnered with Touchstone Imaging. Together under the Touchstone name, we have nine imaging centers throughout the Denver area, to make it convenient for our patients to get x-rays and other imaging services.”

07:00 Pamela D. Wilson: Knowing that there are many of these not always mentioned relationships might have you worried about health and for good reason. There are pluses and minuses to these types of relationships for patients. Pluses might include faster access to appointments and better care coordination with your doctor’s offices. That’s good. Minuses might include eliminating choice by directing you to go to the imaging center when other centers are in your insurance plan that may offer equal or better service, even though they don’t financially contribute to your doctor’s office. These partnerships, they’re usually financial-based in the way of joint ventures, operating agreements, earnings, and cost-sharing.

07:37 Pamela D. Wilson: A conflict of interest in healthcare could also be a doctor who recommends surgery. The doctor practices at two surgery centers. Both of which the doctor and other doctors in the group own and financially benefit from. Does the doctor’s office tell you this? Usually not. However, it might be in the paperwork that you are given—that you don’t read—but you sign. Completing page after page of paperwork, especially if you don’t understand the medical terminology, can have you more worried about health. It’s important that you read, really read all paperwork that you sign, to avoid unpleasant surprises that can have you more worried about health and healthcare.

08:17 Pamela D. Wilson: We will talk more about conflict of interest in healthcare in the second half of this caregiver radio program. Invite your friends, family, and others to listen and follow The Caring Generation for intelligent conversations about caregiving, health, and well-being. Practical tips for caregivers and aging adults are in my Caring for Aging Parents caregiving blog on my website, at Up next, the amazing Sharmila Dissanaike from Texas Tech. She’s going to talk to us on the topic of physician burnout. This is Pamela Wilson. You can visit my website,, for helpful information for caregivers and aging adults. All of the past podcasts from this show are there, that you can listen to or read in transcript form, in addition to videos, online caregiving courses, and more information. You’re with me on The Caring Generation live on the BBM Global Network, Channel 100, and TuneIn Radio. Stay with me. We’ll be right back after this break.


10:37 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host. This is The Caring Generation radio show for caregivers live from the BBM Global Network channel 100 and TuneIn Radio. Joining us is Dr. Sharmila Dissanaike, Chair of the Department of Surgery at Texas Tech University Health Sciences Center. She’s a national leader in promoting better healthcare systems to prevent burnout among clinicians. Doctor, thank you for joining us.

11:03 Dr. Sharmila Dissanaike: Thank you for having me.

11:05 Pamela D. Wilson: So we talk about burnout all the time in the general workplace, but the outside world—non-healthcare—rarely talks about burnout for physicians and surgeons. Does society look at doctors differently? Do they have different expectations?

11:21 Dr. Sharmila Dissanaike: I think so. I think that one reason we see burnout more predominantly in the caring professions and in the healthcare profession in particular, is because I think doctors and also nurses, and all people who work in healthcare, are sort of held up to a higher standard if you will. And I think we’re also having to fill an archetype of what a carer and a healer is, and I think that weighs on us. And if you look at the recent COVID debacle, fiasco, or virus, whatever you want to call it. [chuckle] But clearly, one of the predominant themes was healthcare workers as heroes. And of course, while there’s a lot of good things to that. It also shows how we are expected, similar to some other fields, maybe the military, for example, to go over and above. “I’m going over and above every day. I can take the toll of that.” And so, I think we are a little more vulnerable to burnout as a result of these expectations.

12:19 Pamela D. Wilson: And in medical school—there are some medical students tonight who are listening—it’s challenging. Residents, they work a lot of hours to get a degree. So to your point, they can help people. What are some of the reasons for physician burnout for these residents and then long-term physicians and surgeons?

12:37 Dr. Sharmila Dissanaike: So I think it’s multifactorial, of course. I think the depersonalization of medicine is a real issue. And here’s the interesting thing know that I love physicians and surgeons—and we’ve been doing this a long time, and burnout is growing increasingly in modern times. And frankly, it was harder 20 or 30 or 40 years ago in America and across the world, and so life has just gotten easier. It’s not easy by any means. But it’s got easier and yet we’re burning out at a faster rate. And I think it’s because we’re not working as long hours, but we’re working in front of the computer, and we’re being held to certain rules, and it’s become a bureaucracy and healthcare right now is—unfortunately a for-profit endeavor in most cases. Even if it’s a nonprofit hospital. And so I think all of these things are contributing to undermine the fundamental reason why people went into medicine and into healthcare, and that tension between living every day in a system that isn’t necessarily helping you fulfill your values leads to burnout at a very high rate, and sadly, also to certain things like suicide. And obviously, suicide is a big topic and multifactorial also and depression and things that are probably the biggest contributor. But there does seem to be some component of where those who are in this space become more prone to burnout and depression and suicide, and it’s a really big problem.

14:08 Pamela D. Wilson: Well, and I’m glad you brought that up because I think that a lot of patients don’t realize all the paperwork that doctors have to do and the requirements from the health insurance companies and the fact that they have to get people in and out in 15 minutes. It’s stressful, and the other side doesn’t always see that, which kind of leads to all these stresses. But so not all jobs have what I call these high state consequences like you perform surgery, and somebody could die. How does that level of responsibility raise stress even more?

14:37 Dr. Sharmila Dissanaike: Well, it definitely does. And I would say individuals handle that differently. But I will tell you, honestly, how—if I’m saving someone’s life. Yes, it’s an adrenaline surge. It’s stressful. But it is done. It’s time-sensitive. But it’s also time contained. I do the operation. I take care of the patient, and hopefully, they get better. And even if not, there is a certain finality to it. And I do think the daily grind—the sort of death of a thousand cuts—for me personally. I definitely feel that will be a bigger contributor to daily stress. Every time, for example, I send a patient for physical therapy, I have to fill out probably six to ten pages that have to be signed. Just for that one thing, and now you multiply that by so many patients. And it’s ten pages of fine print that nobody can read. And it’s physical therapy for a patient who needs it, and you think why am I having to do this? This is ridiculous. And so when that builds up over and over and over, that to me is more stressful because the stress of my offering to save a life, “Hey, I know why I’m doing that. There’s a real, very clear indication for what I’m doing. And even if it’s stressful, I know I am doing my utmost best to save a life. And that really to me outweighs a lot.

16:00 Dr. Sharmila Dissanaike: Now, we do have to cope with patient death. And I’ve been doing this now nearly twenty years. So you do get accustomed to it. And I’m a firm believer on offering a patient a good death. A peaceful death is just as important as anything we do to try to save a life and prolong life. And so I have a particular outlook on it that I think has helped me cope with it better than some. I do know that a lot of people do struggle. I will tell you when I had my first death as an intern way, way back, I definitely cried because it’s sad, but you do grow to it. And I’m actually very grateful to work in a job, where I see death all the time, and I am not allowed to forget that every one of us will die. I think that’s a great gift of our jobs. And so just like some of our jobs contributes to burnout, I would say that the part of our job that allows us to see the reality of our own mortality and be reminded every day is actually a huge spiritual and mental health support. If you use it the right way. And so, I kind of look at it through that lens of it is what you make of it from the clinical side. But as you can tell, I’m totally not a fan of the system and the paperwork. Which I feel that’s kind of the part we should focus on in trying to reduce burnout.

17:13 Pamela D. Wilson: Yes, I agree with you. I’ve been in caregiving for twenty years, and when people first would die, I like you would just be crying and but you do learn to accept it and the fact that it is going to  happen to all of us, and I think we can talk about it more. So we’re going to continue our conversation with Dr. Sharmila Dissanaike, whose clinical and research interests are focused on trauma, burns, critical care, and emergency general surgery. The podcast of this radio show for caregivers and all of The Caring Generation podcasts are on my website on The Caring Generation radio page. You can click on the media tab and scroll down to find The Caring Generation radio’s tab there. Stay with us for more information about caregiver burnout and physicians. I’m Pamela D. Wilson. You’re with me on The Caring Generation live on the BBM Global Network Channel 100 and TuneIn Radio. Information for caregivers is on my website at The podcasts of the show are on your favorite podcast sites Apple, Google, Spreaker, Stitcher, and more. This is Pamela D. Wilson, you are listening to The Caring Generation live on the BBM Global Network Channel 100 and TuneIn radio. Stay with me. We’ll be right back after this break.


20:52 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host for The Caring Generation on the BBM Global Network, channel 100, and TuneIn Radio. We’re back to continue our conversation with Dr. Sharmila Dissanaike on the subject of physician burnout. Doctor, before the break, we were talking about all the paperwork. Does this come as a surprise to medical students who want to help people, and then they get through medical school, and they have to fill out all these forms, and they’re thinking, “Well, nobody told me about this.”

21:22 Dr. Sharmila Dissanaike: I think so, and I think that one of the problems is that how they find out, is that they start rotating with physicians and seeing them, and then, of course, the physicians are always grumbling about the paperwork. Because that’s what we do. And I think it’s very disillusioning for them to realize that this is a lot of what modern healthcare is. And, so yes, I think it is quite different to what they had envisioned. And it’s just the sort of over the years there’s been this metastasis of paperwork, of where something so benign and so banal is so tied up in legal and insurance paperwork that it just, like I said. What should be a quick one form or one click becomes 15 and 10 pages, and it just keeps getting worse. And so I do think that that, maybe, disillusions people early on.

22:17 Pamela D. Wilson: And so, physicians always talk to their patients about exercising and eating healthy, does the systems where the doctors work—do they talk to doctors about wellness activities and managing stress, or is that—just doesn’t happen?

22:34 Dr. Sharmila Dissanaike: No, actually it does a lot, and I’d say there’s two sides to the issue. There’s no doubt that a healthy diet and exercise and trying to go to your physician and your dentist, those things are incredibly important. And I do think that a lot of companies, a lot of hospitals, and a lot of medical schools are now really promoting that. Because we’ve realized that has been neglected. On the flip side, there’s a dark cynicism. I would say, among many physicians, that the solution for burnout is to prescribe a yoga class and meditation once a month, and it’s mandatory. If you don’t do that, you’re in trouble. And it’s sort of viewed with some dark humor that that’s the corporate solution to burnout. And the problem with it is that while those things are good in and of themself, burnout is ultimately a system problem. It’s to do with how we deliver healthcare, and it doesn’t matter how much yoga, meditation, and apples you eat if we don’t address the core problems in the system, we’re not going to fix burnout. And so, there’s almost; I don’t want to say backlash, it’s too strong a word. But I think it needs to be balanced, and we need to understand that that is great. But they’re adjuncts. They’re not the actual solution.

23:53 Pamela D. Wilson: Well, and I think that applies to any workplace, whether it’s physicians or other workplaces, which leads me to this next question. A lot of people change jobs every two to three years. If you become a physician and you invest all those years in school and all the expense, is there more pressure to continue to do that for 20 or 30 years? You probably think, “Oh my gosh, I do this. I can’t leave being a physician.” What do people do if they ever decide to leave?

24:18 Dr. Sharmila Dissanaike: So, absolutely, people do not tend to leave, and I’ll tell you why. In addition to the pressure and—it’s the human concept of you’ve sunk a lot of investment into becoming a physician and so you can’t just give that up. However, what’s also important is that true financial cost of it. It’s not just emotional in effort and energy. It’s money. Medical school is expensive. A lot of people graduate in significant debt, and they take a while to pay that back. So there are some practical, as well as emotional, reasons why people don’t tend to leave. And while people move around between jobs and between hospitals, a majority of physicians do stay in medicine for their entire careers, for at least 20, 30, 40, 50 years.

25:08 Pamela D. Wilson: And that, I think, is rare and it’s amazing to me. So you are out and about, you write, you present to a lot of professional groups about physician burnout. When you’re talking to people, what are you saying? And how do you manage your burnout? I don’t want to put you on the spot, but I want to ask that question to you.

25:25 Dr. Sharmila Dissanaike: No. I think it’s a great question. So when I talk to groups about burnout, they’re usually surgeons and physicians, I will say exactly what I’ve told you, that when we talk about truly fixing burnout, we need to look at structural things of the system. So, for example, with surgery, and trauma surgery in particular, I moved us from the 24-hour call model, which really results in a lot of stress and a lot of burnout, and a lot of sleep deprivation, to a shift model where people just work 12-hour shifts and then go home, like most normal people. Like nurses and ER physicians.

26:00 Dr. Sharmila Dissanaike: People who work jobs in other industries, nobody thinks that 24-hour call is a great idea anywhere but in medicine, and so there are some very practical things you can do to help reduce exhaustion and reduce burnout, and so I try to point to those things. Those very practical things. And then on a personal level with people want to use the adjuncts, I think meditation is fabulous. It’s called to my life. That’s actually how I got into this work originally, and so I don’t ever promote it as a solution to burnout. But I do think it’s a way that people can just help themselves live in an incredibly difficult world, and so. I do promote both personal as well as systemic change when I talk to other people, and that’s what I do in my personal life as well.

26:45 Pamela D. Wilson: And we’ve got about a minute left, so there are some medical students listening. What advice do you have to them about burnout or any advice that you would want to give?

26:58 Dr. Sharmila Dissanaike: I would say that set up a structure to manage your own health now. Get into good habits, good practices that will last you for life. And look for the joy in what you do. Look for the service in what you do. If you are always focused on what you can give back to the world and what service you can provide. That’s actually to me quite protective against burnout versus what can this world and what can this job do for me today? I do think that that service mindset does protect you a little bit. Maybe not all the way, but I think it protects us a little bit from the effects.

27:34 Pamela D. Wilson: Thank you. And if people are interested in following you on Twitter, what’s your Twitter handle?

27:40 Dr. Sharmila Dissanaike: It is @DissanaikeMD.

27:43 Pamela D. Wilson: Perfect. I will make sure that I share that in the show notes for this program. Dr. Dissanaike, thank you so much for joining us and sharing all of that information. Listeners, you can follow and share The Caring Generation radio show on your favorite podcast apps. This show will be up in about a week. You can go to Apple, Google, Spreaker, Spotify, Stitcher, Pandora, it’s on iHeart Radio, Castbox, you can even listen on Amazon Alexa. Check out my website for helpful information for caregivers and aging adults. My book is there, The Caregiving Trap. My Caregiving Blog with a lot of articles, caregiving library hundreds of videos, and my caregiving courses. This is Pamela D. Wilson, your host. You are with me on The Caring Generation live on the BBM Global Network Channel 100 and TuneIn Radio. Join us every Wednesday night, six o’clock Pacific, seven Mountain, eight Central, and nine Eastern. We have amazing guests like Dr. Dissanaike, who joined us this evening. Stay with me. We’ll be right back.


31:07 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host. You’re listening to The Caring Generation radio program for caregivers, and aging adults live from the BBM Global Network channel 100 and TuneIn Radio. The Caring Generation focuses on the conversation of caring, giving us permission to talk about aging, the challenges of caregiving, health, and everything in between.

31:29 Pamela D. Wilson: We’re back to talk about how being worried about health can translate to being a vulnerable healthcare consumer. Including the idea of leaving against medical advice that we’ll talk about later in this show. How many of you expect your healthcare providers to be ethical and do the right thing? Many consumers have this belief—until something happens, that makes you start asking questions. How can you avoid conflict of interest in healthcare? One solution, as I’ve mentioned before, is patient education and engagement. Including articles, videos, and online programs available on my website at Let me share two more examples that might have you worried about health—but understand conflict of interest in healthcare a little better.

32:17 Pamela D. Wilson: When you receive a healthcare bill in the mail, do you compare that bill against the EOB? EOB is medical speak term for Explanation of Benefits, that comes from your health insurance company. If you don’t, this comparison is a must. Here’s why. An example: a healthcare provider sent an invoice for the deductible and the co-pay portion of a service. What the healthcare provider didn’t do was confirm that the mandatory co-payment to even receive services—that was made on the date of the service—was paid. And that more than covered the amount that they were billing. I called the health insurance company to verify this information, and then I left a message at the doctor’s office, telling them that they owed the patient money. Not the other way around. The patient didn’t owe them.

33:03 Pamela D. Wilson: Another more concerning example is a patient who had surgery scheduled on a Monday. The patient did their thing—this person called Wednesday of the week before to confirm that the insurance company had approved the surgery, and the doctor’s office said yes. The surgery was approved. Everything was good to go for next Monday. Two days later, which was Friday before the surgery, the patient got a voicemail from the surgeon, saying that the insurance company denied the claim and that the surgery was cancelled. And by the way, the surgeon was leaving the current practice, to work at a new practice at the end of the month. Put yourself in the position of this patient. Worried about health? Not to mention you’ve been waiting two months for the surgery. How would you feel? More anxious and worried about health? Panicked that you’re feeling horrible, and now that surgery that you thought would make you feel better, has been denied? What do you do? If you’re smart, you call the new doctor’s clinic. And unfortunately, you find out that they can’t schedule the surgery. That you have to wait to schedule a new patient appointment and start all over again. Now, you’re worried that it could be months before you’re scheduled for surgery. What is wrong with this picture? What else could you do? What else should you do, besides the obvious of wanting to scream?

34:26 Pamela D. Wilson: Here’s the other side of the story, that makes this more complicated, because of involving the health insurance company. A call to the health insurance company led to statements by the call representative that the surgery request was never submitted for approval. There was no record in the file of any correspondence from the doctor’s office. Next step, email the doctor’s office. Email says, “I’m worried about health concerns that have been going on for months. I’m concerned that you told me my surgery was approved, and today, to my surprise, surgery was canceled by the surgeon Who by the way, told me she’s moving to a new medical practice at the end of the month. Can you email me copies of your correspondence with my insurance company, as they’re saying nothing was submitted for approval?”

35:11 Pamela D. Wilson: A second call was made to the insurance company, to another department. Now, the insurance company is saying that they used a third party to gain approval, and they have a partnership agreement with a company who reviews these surgery requests. Another 40 minutes on the phone, and guess what? Found out that the surgery was approved two months before. As you will learn, you will get different stories from different people that you call at health insurance companies. But here’s the conflict of interest in healthcare: The agent reported that the surgeon made a call to that third-party company four hours earlier in the day to, guess what? Voluntarily cancel the surgery. What do you think about this? Did the surgeon cancel the surgery out of a conflict of interest in healthcare?

36:00 Pamela D. Wilson: Fact. What do we know? The surgeon is moving to a new medical practice. Surgery, as we know, very expensive. Why not delay the surgery until the surgeon is at her new practice, and transfer that revenue to the new practice, rather than contributing revenue to the practice she is leaving? The surgeon didn’t think that the patient would have an investigation completed. Most people don’t. Most people don’t know what steps to take. So, the doctor thought—with all the layers in the insurance company—nobody would find out that that surgery was approved and that she voluntarily canceled the surgery. My opinion—that action was clearly financially motivated. The physician wasn’t acting with the primary goal of patient care and a physician’s oath to do no harm. Can you guess what happened next? The doctor’s office called and said, “Oh, there was a horrible mistake,” and that the surgery was reconfirmed for Monday.

36:57 Pamela D. Wilson: Yay! The patient wins on this one. But now you’ve got a dilemma. The patient is worried about trusting the surgeon, who appears to be more interested in money for her new medical practice. Because of this conflict of interest in healthcare—what would you do? Would you report the surgeon to the insurance company? Would the insurance company do anything? Will they see that surgeon’s actions as a conflict of interest in healthcare, at the expense of the health and well-being of a patient who, by the way, pays premiums every month to that health insurance company? Should a report be made to the Medical Board? To the State Department of Health? Would any of these organizations really care how the patient was affected?

37:38 Pamela D. Wilson: This is the dilemma that vulnerable caregivers and aging adults face when dealing with a conflict of interest in healthcare. Consumers are often treated poorly. Concerns exist about patients making a report. Even though many other consumers are probably experiencing the same unethical treatment. If a complaint is issued, the patient may have to start all over again with a new medical practice, out of concern that the surgeon might purposely harm the patient during surgery. Worry about retribution stops many consumers from filing complaints.

38:12 Pamela D. Wilson: More on this after the break. Follow me on Facebook. My Facebook page is On there is my caregiver support group called The Caregiving Trap. This is Pamela D. Wilson, on The Caring Generation. Coming to you live, from the BBM Global Network, Channel 100, and TuneIn Radio. Stay with me. We’ll be right back.


40:51 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert, author, and speaker on The Caring Generation, coming to you live from the BBM Global Network, Channel 100, and TuneIn Radio. Information for corporations and human resource departments about elder care and caregiving, on-site education, webinars, video conferencing, talent optimization, and virtual training programs is on my website at We’re back to continue our conversation about being worried about health, and how caregivers and aging adults can manage through conflict of interest in healthcare. In the example we talked about before the break, one option would be to find a new surgeon and then issue the complaint to avoid possible retribution or harm. This might not be an ideal solution, especially if the surgeon’s skills are rare.

41:43 Pamela D. Wilson: It’s unfortunate, in my opinion, that a surgeon would place a patient in this type of situation, where financial interest appears more important than patient care. Why do healthcare professionals think this type of behavior might be ok? Honestly, some don’t think. They don’t know better. Not all healthcare organizations focus on ethics, professional training, or boundary training. Reversing this. It’s the reason many family caregivers find themselves in trouble when working with healthcare providers. Boundaries are easily blurred. Resulting in everybody being worried about health. I’ll share a basic situation with a home care provider, to show how the actions of a family caregiver can unintentionally result in a conflict of interest in healthcare.

42:31 Pamela D. Wilson: Let’s say that you hire a caregiver for an elderly parent through a care agency. The caregiver is very likable. You begin sharing personal information about your parents, and you feel that this caregiver is a good friend and a confidant. All of a sudden, the caregiver stops showing up on time. Isn’t getting his or her work done, eating your parent’s food, acting as if this caregiver is part of your family. You don’t like this new side of the caregiver. But you’re concerned about telling on the caregiver to the agency. What happened here? You, as the family caregiver, caused this change in behavior by the hired caregiver, through your behavior of making the caregiver your friend and confidant. You may not have realized this would not be helpful. Unintentionally, you crossed the boundary between professionalism and friendship, and the caregiver followed you. Now, you’re worried about the caregiver getting fired because of your behaviors. This is an example of good intentions gone wrong, and it’s one of the most common issues in hiring and working with in-home caregivers.

43:35 Pamela D. Wilson: When family caregivers or the hired caregiver lack boundaries, it’s easy to create worries about the health and care of elderly parents and the conflict of interest in healthcare that’s created. Now, what? If you’re the family caregiver, I suggest contacting the care agency and taking responsibility for what happened. Be honest, ask for a new caregiver. Yes, you are starting all over training a new caregiver. But this time, you should know more about maintaining professional boundaries. Similar situations are when private caregivers are working for a company, and they ask a family to hire that caregiver privately. That’s not allowed. When caregivers take the liberty of bringing their children to work, that’s another problem. Talking on their cell phones during their shift, and taking all kinds of liberties that result in work not getting done. That’s what they’re paid for. Some will arrive late and leave early, that’s another concern. What’s the lesson here? When you hire a caregiver through an agency, ask for their policies around ethics, professionalism, and boundaries. Learn what is considered appropriate for client behavior. Learn what the caregivers are expected to do and the boundaries that they should maintain, and don’t cross them. This probably includes not giving you their personal phone numbers and talking about their personal lives. Don’t ask those questions. [chuckle]

45:02 Pamela D. Wilson: Avoid the temptation to place agency caregivers in difficult positions that can get them fired. Many don’t have the experience or the confidence to talk about company policies. Instead, they have good intentions, want to do a good job, and they want you to like them. This situation is the same for a host of other service providers who become friends with or who become overinvolved in the lives of their clients. These include CPAs, housekeepers, massage therapists, mental health counselors, visiting nurses, staff in care communities, sometimes attorneys. The list is endless. Friends are friends. Service providers should remain service providers. If you want to change the relationship, then find a new service provider. Conflict of interest in healthcare can have unintended consequences that can have you more worried about health, yours, or an aging parent. We talked about the potential conflict of interest with doctors, doctor’s offices, and in-home care agencies.

46:03 Pamela D. Wilson: Let’s talk about the conflict of interest in healthcare that can have you worried about health when an elderly parent lives in an assisted living community, or memory care. I call this conflict of interest in healthcare, territorialism. This is when your elderly parent has lived in a care community for some time, and the staff feels like your parent is part of their family. It’s easy to be worried about health and the care of elderly parents, when care community staff sees you, the family member, as an outsider or the bad guy or gal. Especially if you are the power of attorney or the guardian. Complications breed when your elderly parent speaks to the care providers and to the staff, and they talk negatively about you. When I was a court-appointed guardian and a power of attorney, I was in the situation that many family caregivers find themselves in when there’s a family disagreement that creates these opposing sides between the elderly parent, brothers, and sisters, the primary caregiver, and the care community. It’s easy to become worried about health and hesitate to address that situation. Digging your head in the sand is not going to solve the problem. Talk to your parent, your brothers, and sisters, and the staff at the care community to address the concerns so that you can solve that problem.

47:23 Pamela D. Wilson: Primary caregivers do best when you learn how to resolve conflict. How do you learn that? More practical tips, proven solutions, and support for caregivers are in my book, The Caregiving Trap: Solutions for Life’s Unexpected Changes. Information about the book is on my website at, where you can also find my online course for caregivers. It’s called Taking Care of Elderly Parents, Stay at Home, and Beyond. You can ask for this program through your corporations and through your groups. Up next, we’re going to talk about AMA, which is “against medical advice.” What happens if you want to leave a hospital or a care community against the medical advice of doctors? Do you or don’t you? Visit my website for more information. I’m Pamela D. Wilson, caregiving author, expert, and speaker. This is The Caring Generation, live from the BBM Global Network, Channel 100, and TuneIn Radio. Stay with me. We’ll be right back.


50:39 Pamela D. Wilson: This is Pamela D. Wilson, Caregiving expert. I’m your host. This is The Caring Generation radio program for caregivers and aging adults, live on the BBM Global Network, channel 100, and TuneIn radio. Please share The Caring Generation with your friends, family, co-workers, and the companies where you work, your social groups, at church, and everywhere. One in four people you know are caregivers looking for hope, help, and support, that is here on The Caring Generation every Wednesday, and on my website 24/7 at Coming up next week, more answers to caregiver questions, what are adult day care programs, and how to make friends at any age with Dr. Jeffrey Hall from the University of Kansas.

51:22 Pamela D. Wilson: Let’s wrap up conflict of interest in healthcare with the idea of leaving against medical advice. If you have an elderly parent who goes to the emergency room, a nursing home, or an assisted living community, you might receive cautions from doctors or staff that warn your parent about the risks of leaving the community to return home, or just caution about healthcare concerns. Some of the concerns are valid. Others may not be.

51:51 Pamela D. Wilson: Caregivers often hear, “Your mom or dad needs 24-hour care.” Without being given any reasoning of why. Caregivers then feel threatened that something horrible will happen if they make the choice to return an elderly parent home. In situations where medical type care is needed, for example, blood sugar readings to manage diabetes, or managing a feeding tube, caregivers might be fearful that they can’t learn these skills, or just the opposite, caregivers know that by learning these skills, an elderly parent can return home, which is against medical advice.

52:31 Pamela D. Wilson: This choice against the recommendations of a physician or care staff at a community, it’s totally up to you. I go back to you. You are the caregiver. You and your elderly parent should know more than anyone else about what your elderly parent wants, and what you’re able to do as a caregiver. You can always set a trial period, and if it doesn’t work out—if your parent is not doing well, or if there are other worries, then you put plan B into place. Always have a plan A and a plan B, sometimes a plan C, to address unexpected caregiving issues. Be flexible in your approaches. Commit to learning. Ask questions. If you take actions that are AMA, against medical advice, it’s up to you to take every action to succeed.

53:22 Pamela D. Wilson: Caregivers ask if insurance companies will pay for a nursing home stay if a parent leaves against medical advice. The answer, usually yes. However, again, it’s up to you to verify this information with your insurance company. Similar to the example I gave earlier in the program, about the surgeon voluntarily canceling the surgery and that investigation. Talking directly with the health insurance company of an elderly parent puts you in the driver’s seat. You don’t have to allow doctors or any healthcare provider to threaten you when you have the facts. While many healthcare providers are wonderful and have good intentions, conflict of interest in healthcare exists. Keep asking the question, “Do you have any conflicts of interest? Partnerships, or exchange of money, goods, or services that I should know about before I decide to use your services.” Get the information upfront, so that you can make a good decision about whether or not to use the provider. You’ll avoid complications later.

54:26 Pamela D. Wilson: As a caregiver and aging adult being worried about health—it places you in a vulnerable position—that can be very uncomfortable. What you don’t know can get you into trouble. The questions you don’t ask can cause problems. Take the initiative to learn to become a more informed caregiver. You’ll gain confidence that helps you become an advocate for yourself and aging parents, and avoid conflict of interest in health care through patient education and engagement. Ask for the help, the education that you need from the healthcare system, your families, and the workplace.

55:05 Pamela D. Wilson: Caregiver support, in the way of articles, videos, online programs, my library, the podcast of this radio show are on my website at If you have ideas for future programs, all of these ideas for these shows come from you. You can visit my website, Click on the contact me button, and send me an email. You can also message me on Facebook. My page is Invite your friends and family to join us here every Wednesday night on The Caring Generation radio show. I am Pamela D. Wilson, caregiving expert, advocate, author, and speaker. God bless you, sleep well tonight, have a fabulous day tomorrow, and a great week until we are together again.


55:54 Announcer: Tune in each week for The Caring Generation with host Pamela D. Wilson. Come join the conversation and see how Pamela can provide solutions and peace of mind for everyone. Here on Pamela D. Wilson’s The Caring Generation.


Looking For Answers to Working With Healthcare Providers? Read this caregiving blog post Making Patient Education and Engagement a Reality.

About Pamela Wilson

PAMELA D. WILSON, MS, BS/BA, NCG, CSA helps caregivers and aging adults solve caregiving problems and manage caregiving needs through online programs, live support groups, and an extensive caregiving library that includes articles, podcasts, videos, and webinars.

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