Virtual Mentor

Bander Essay Contest in Medical Business Ethics

The Bander Essay Contest is supported by the Saint Louis University Bander Center for Medical Business Ethics. The contest is meant to encourage scholarly inquiry into business ethics within the practice of medicine or the conduct of medical research.

Medical students, resident physicians, fellows, and physicians in practice are eligible to submit essays for consideration. Essays must be 2,000 words or fewer, typed, and double-spaced. The author’s name, address, telephone number, e-mail address, and affiliation (medical school and class, private practice site, hospital affiliation, etc.) should appear on the cover sheet only—not on the essay pages. Entries must be received as e-mail attachments by 5 p.m. CST, February 15, 2011. Submit essays to Faith.Lagay@ama-assn.org.

A peer-review committee established by the Virtual Mentor editorial staff will select contest winners. Essays will be judged on understanding of the topic, applicability of the proposed policy to medical practice and patient care, clarity of writing and argumentation, and integration of relevant scholarly literature and data if appropriate.

The author of the best essay will be awarded $5,000. If more than one exceptional entry is received, up to three runner-up prizes of $1,000 each will be awarded. Winning essays will be published in Virtual Mentor.

2009 Winning Essay

2010 Contest Scenario

Dr. Bunell was surprised to see Mrs. Scott and her second-to-youngest child when the office assistant showed them into his exam room.

“Long time, no see, Mrs. Scott,” he said. “Everyone’s been well, I take it?”

“Well, I’m worried about this one, “ she said, looking down on her son who sat in her lap. Dr. Bunell figured he must be about 5 years old by now.

“I’ve been taking the boys [she had four] to the SureCare Clinic at the mall for the last 2 years,” Mrs. Scott said. “I can get their immunizations there, get them seen for colds and bouts of poison ivy. My oldest even got his physical to be on a pony league team last spring.” She took a breath. “And it’s so quick and far less expensive than coming here. With a family of six,” she said, “it makes a huge difference in medical bills.”

Before Dr. Bunell could speak, Mrs. Scott started again.

“But, we’ve been treating this one,” she looked down again, and Dr. Bunell wished she’d say the lad’s name because, to tell the truth, he’d forgotten it, “with antibiotics for 3 weeks and he seems to be getting worse, not better. Just look at him.”

Visits like Mrs. Scott’s were becoming familiar to Dr. Bunell. More and more of his patients were showing up after long periods during which he figured they had been well and had had no need for medical care. He found out, instead, that they had been going to retail clinics for the “everyday stuff,” and making appointments with him only when something more serious cropped up. It would be months or years since he had seen them and he’d have no record of what had transpired at the clinics.

A family practice specialist, Dr. Bunell did not know the best and most professional way to manage this situation. Some of his colleagues had told their patients that  they (the physicians) had to manage all the care or none. But Dr. Bunell didn’t know if that was ethical; besides, it was entirely unenforceable. How would one know if a patient had received care elsewhere between visits to the doctor’s office?

On the other hand, Dr. Bunell’s practice depended on routine immunizations, sports physicals, and treatment of everyday infections and injuries. He wasn’t a hospitalist, after all. This was a medical and business problem, as he saw it.