An unknown percentage of physicians and others rendering health care services do so unethically, with a wide variety of abuses such as: practising without the proper educational qualifications; practising without required licences and registrations; over-charging; negligence; erroneous, unwarranted or uncertain prescriptions, treatments or surgical procedures; supervising, monitoring or conducting torture; and sexual misconduct with patients. There may be unethical disclosure of a patient's medical history to employers, credit investigators, banks, attorneys and others; and sexual contact may be initiated by the practitioner with his or her patients. Practitioners may accept bribes or excessive fees for expert testimony, and they may make narcotics and other substances that can be misused available to those in their care. They may perform illegal abortions or treat unreported gunshot wounds. The problems of ageing and incurable terminal conditions and diseases are susceptible to medical fraud. Ineffectual cures may be offered for everything from cancer to baldness.
Practitioners, notably doctors, may abuse their positions of power in institutions to encourage or sanction practices that are not in the interests of patients, and may further abuse that power to conceal their involvement in such practices, or their responsibility for them. Typically this will include issues related to the institutionalization or treatment of patients. There is seldom any degree of serious professional control over efforts by physicians to maximize their income and those of their colleagues by creating conditions for an excessive number of consultations, referrals, tests and treatments, often at the highest price that patients or health insurance will tolerate, whatever economic sacrifice the patient is then obliged to make, and whatever the wider social costs. Under other circumstances, institutional power may be used to exploit health insurance systems to the mutual advantage of the professional and the patient. Typically there is a complicity between doctors and employees in seeking medical certificates as a cover for absenteeism or, on a longer term basis, to justify extended periods of treatment (and even retirement) as a result of occupation-related illnesses or disability. Thus, in order to achieve maximum disability insurance for a longer period, a higher level of disability may be certified than is justified. There is also complicity with the pharmaceutical industry in recommending products, whatever their cost to the patient or to the medical insurance system.
The medical profession has demonstrated considerable skill in protecting and extending its functions and privileges, notably by exploiting the confidence traditionally projected onto healers and by cultivating a caring image in appropriate situations. As part of this protective process, every effort tends to be made to ignore, criticize and marginalize alternative approaches to healing, even when they have been successfully practised for centuries in other cultures. To this end legal sanction against the investigation, teaching or use of such approaches, or the certification of its practitioners, may be sought by exploiting the privileged institutional position the profession enjoys. This may even indirect support for media campaigns through which alternative practices are systematically denigrated. Typically the profession has exhibited extreme resistance to such techniques as acupuncture and the use of certain herbal medicines (from which subsequently key chemicals are extracted for use in high priced pharmaceutical products). There is inability to distinguish between cultivation of healing skills and the defence, at whatever cost, of the social and economic interests of the profession.
There are always isolated examples of abuse, but the people and groups involved are unrepresentative of the profession.