Conflict of interest: the elephant in your practice.

One of the core and essential elements of clinical practice, and in fact for all professional traditions, is the fiduciary relationship, in which the primary interest is to serve solely for the benefit of patients. In our increasingly complicated world a myriad of secondary interests always threaten to subvert our fiduciary obligations. These secondary interests may include financial gain from third parties, a desire for professional advancement or recognition, favours to significant others (such as colleagues or families), and even religious or political demands. When our professional judgement with respect to our primary interest is unduly influenced by our secondary interests there exists a conflict of interest. This has to be differentiated from the dilemma of 'dual agency' that usually occurs in forensic settings when from the outset the practitioner is faced with conflicting responsibilities or loyalties owed simultaneously to the person being examined and other third parties.