An entrenched form of fee splitting in private healthcare is when diagnostic facilities allow referring doctors to collect the full charges for tests from their patients.

The doctors are then billed at a later date, minus the discounts from the laboratory or radiology centres.

It is such schemes rather than the overuse of technology that lead to the excessive ordering of diagnostics in private healthcare (Doctors play pivotal role in curbing overuse of technology, by Mr Sim Lim Onn; Sept 15).

There are also concerns that doctors may over-investigate, as such rebates have been around for years and act as an incentive for clinicians to ask for more tests, which is undeniably a conflict of interest in medicine.

Patients can never be completely certain that they genuinely require those tests.

Doctors' fees alone are not responsible for the escalating cost of healthcare. However, fee sharing probably plays a major part in causing patients to fork out more for diagnostic services.

The splitting of fees is unethical, but is such an established and widespread practice in the private sector that most doctors eventually get sucked into it. Once a critical number is involved, the others have no choice.

Diagnostic centres know that paying commissions to doctors will ensure a steady stream of referrals.

To counter the competitive advantage of the first mover of such promotional schemes, other diagnostic facilities will start to offer even more generous incentives.

For a profession where credibility rests almost completely on trust, this perception of escalating greed in private healthcare is doing irreparable damage to the doctor-patient relationship.

In order to preserve the integrity of their professional judgment as well as promote public trust, doctors must not allow their decisions regarding a primary interest to be unduly influenced by any secondary concerns.

Edmund Khoo Kim Hock