QUESTION: I am a podiatrist, and I have been approached by a software salesman in the podiatrist industry who is promoting a software package that is designed to recommend different treatment protocols for different foot ailments. When I reviewed what the software recommended for each ailment, it became clear to me that the treatment plans were designed primarily to maximize the number of doctor visits and treatments. This appears to have been done to maximize the amount of money the client / insurance company can be billed for rather than to provide the optimal patient care.
Here are some specific examples of what the software recommends for:
- Heel Pain: It suggests that every heel pain case should automatically follow a 6-visit sequence: initial consultation, diagnostic imaging review, custom orthotic fitting, follow-up adjustment, progress evaluation, and final assessment - regardless of whether the patient improves after visit 2 or 3.
- Plantar Fasciitis Treatment: It recommends a mandatory 8-session protocol including multiple physical therapy referrals, follow-up appointments and additional procedures, even for cases that might be resolved with simpler interventions.
- Routine Nail Care: It is pushing to convert simple nail trimming into multi-visit "nail health management programs" with unnecessary follow-ups.
- Diabetic Foot Care: While this legitimately requires careful monitoring, the software recommendation seems to schedule more frequent visits than is medically necessary, potentially exploiting patients' concerns about their condition.
The software salesman presents this as "evidence-based treatment optimization," but it is clear to me that the primary goal is to increase the number of billable visits per patient. He even showed me the projected revenue increases that could be realized upon implementing the software’s recommendations. This feels fundamentally dishonest to me – it is putting profit over patient welfare and essentially amounts to theft from patients and insurance companies. Patients trust me to provide appropriate care, not to follow a profit-maximizing algorithm that may involve unnecessary treatments.
Am I right to be concerned about the ethical implications of the above, or am I being overly cautious about what might be a legitimate form of podiatrist practice management?
ANSWER: You are correct to be deeply concerned about this software and its treatment recommendations. There are multiple, serious violations of Halacha that appear to be occurring:
Geneivas Daas (Deception)
The Gemara in Chullin 94a establishes that Geneivas Daas applies universally - to Jew and Gentile. The Mishna in Bava Metzia 59b specifically forbids mixing old produce with new and selling them as one package - directly analogous to mixing necessary medical procedures with unnecessary procedures into a single "protocol."
Midvar Sheker Tirchak (Distance Yourself from Falsehood)
The verse in Shemos 23:7 commands us to "Stay away from a false matter." The Chofetz Chaim in Ahavas Chesed understands this charge, as a broad Torah prohibition against lying, especially when monetary gain is involved. The Sefer Chareidim (Mitzvos of the mouth #26) states that even falsehood causing no direct harm violates Torah law.
Using this software, would also transgress the prohibitions of overpricing (Ona’ah) - (Choshen Mishpat 227:21) and of deceptive practices (Rama’us) - (Choshen Mishpat 228:9).
In addition to the above, it goes without saying, that medical professionals are often held in high esteem and are commonly thought of as trustworthy providers of care. Abusing that trust by using this profit maximizing software is particularly egregious.
In sum, your concerns are legitimate. The Rashbatz quoted in the Sefer Chareidim asks: "What else could the Torah possibly expect of us other than complete truthfulness?” Implementing software recommended protocols to maximize profit while presenting them to clients as medically optimal violates multiple fundamental Torah principles regarding honesty, financial ethics, and professional integrity.
