Core Principle

Rule: Primary duty to pt welfare supersedes secondary interests (financial gain, personal relationships).
Default Exam Strategy: If an offer/situation creates even the appearance of bias, decline or disclose.

High-Yield Rules by Category

1. Pharma Gifts & Industry Interactions

ACCEPT:
- Modest items directly benefiting pt education/care (e.g., anatomical models, pt brochures).
- Drug samples for indigent/uninsured pts.
DECLINE:
- Direct travel, lodging, or conference registration fees.
- Personal gifts (event tickets, dinners, electronics) or branded office supplies (pens, pads).
- “Per-patient” referral/finder’s fees for clinical trials.

2. Treating Self & Family Members

General Rule: Unethical (compromises objectivity and physical exams).
Exceptions:
- Emergencies (until emergency care/PCP takes over).
- Minor, acute, self-limiting issues (e.g., simple OTC advice, single dose Abx for acute uncomplicated UTI).
Strict Prohibition: Never prescribe controlled substances (opioids, sedatives, stimulants) to self or family.

3. Financial & Referrals

Fee-Splitting / Kickbacks: Illegal and unethical under all circumstances.
Self-Referral (Clinician-owned facilities): Must disclose ownership interest and provide alternative options without coercion.

4. Romantic & Personal Boundaries

Current Patients: Absolutely unethical (requires formal termination and transfer of care first).
Former Psychiatric Patients: Never permissible at any time.

Rapid-Fire Exam Scenarios

Presentation	Correct Next Step
Pharma rep offers funded trip/hotel for CME	Decline travel funding
Rep offers anatomical chart for exam room	Accept (direct pt educational benefit)
Family member requests chronic opioid refill	Decline; refer to PCP
MD owns stock in imaging center	Disclose financial tie + offer alternate centers
Industry-sponsored research publication	Disclose all funding to IRB and journal
Pt asks MD on a romantic date	Decline; re-establish professional boundaries