Problem
Dr. Waterman had a 12-year-old general pediatrics practice in a rapidly growing suburban community. Although well liked by his patients and their families, he found it increasingly difficult to thrive as a solo practitioner under a managed care system. After careful consideration, he decided to merge his practice with a fairly new pediatrics group in the same community.
During merger negotiations with his three new partners, Dr. Waterman agreed to a compensation formula based largely on the number of patients seen. His new partners, led by the ambitious Dr. Connolly, have also made no secret of their desire to increase the "market share" of the practice and the importance of securing a strong foothold in the community before more competition "moves in."
In the winter, a few months after the merger, the office was flooded with anxious parents and their sneezy, sniffling and coughing youngsters. Ever since a medical school buddy told him about a case of community-acquired MRSA (methicillin-resistant Staphlococcus aureus) he had encountered, Dr. Waterman has been particularly sensitive to the threat of antibiotic resistance. He has therefore adjusted his prescribing pattern over the last few years to minimize antibiotic use. Although it requires more clinic time, Dr. Waterman is careful to explain to each parent why antibiotics might not be indicated for his or her child and what can be done to manage cough and cold symptoms at home.
The clinic was characteristically overbooked one Saturday in January, and Dr. Waterman was called in to see patients even though it was his day off. Assisted by Joan, the clinic nurse, he examined one of Dr. Connolly's regular patients, a 4-year-old boy named Colby. Dr. Waterman told Colby's mother that he suspected his symptoms were due to a respiratory virus and would not therefore prescribe antibiotics. She listened attentively to what he said and then became somewhat agitated, arguing that Dr. Connolly always gave Colby an antibiotic "just to be safe." In fact, as she told him, she had spoken with Dr. Connolly that morning and he had specifically told her to bring Colby in for an antibiotic prescription. "Now, after listening to what you told me, I am just confused." As the clinic nurse slipped out of the room, Dr. Waterman tried yet again to alleviate her anxiety and explain his reasoning.
Suddenly, Dr. Connolly opened the door and burst into the examining room with Joan at his side and gave Colby and his mother a big smile. "Everything going all right?" he asked. "I have your prescription right here. Sorry about the delay." Later on, Dr. Connolly sympathetically told Dr. Waterman that making parents you haven't met before "happy" isn't always easy and that he was glad he could "help out" with Colby's case.
That evening, after everyone had left the clinic, Dr. Waterman looked through every one of the past week's charts. He noticed that Dr. Connolly and the other two pediatricians regularly prescribed antibiotics inappropriately. He also observed that they each managed to see about 20 percent more patients than he did.
If Dr. Waterman approached you, as the Clinic Administrator, what advice would you give him to help resolve this ethical dilemma?