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Should Physicians Disclose Potential Conflicts of Interest to Patients?

Screen Shot 2013-12-18 at 11.37.00 AMTuesday night’s Healthcare Leaders (#HCLDR) Twitter Chat was hosted by Dr. Leana Wen, the co-author of  “When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.” Dr. Wen is also the founder of Who’s My Doctor? – a movement dedicated to promoting and driving transparency on the part of physicians. According to the movement’s website, “We believe that patients should know who their doctors are. The most basic level is where their doctors get their money: are they getting paid by drug companies and medical device companies? Are they getting paid more to do more tests or procedures? All of these factors may influence patient care, and patients have a right to know. Another level is in choosing your doctor. Having information available about doctors’ philosophies and personal views allows patients maximal choice in selecting a doctor whose views align with their own.”

Who’s My Doctor is actively recruiting physicians to take the transparency pledge – they call it the Total Transparency Manifesto. Here’s a link to Dr. Wen’s public disclosure statement.  You’ll see that the statement is quite involved. Dr. Wen details her professional background and training, sources of income that might represent a conflict of interest (pharma, device manufacturers, etc.), revenue streams (clinical, research), and even personal information such as date of birth, family info, social habits and volunteer activities.

Dr. Wen believes, and research would support her in this, that patients are more likely to comply with recommendations that come from a physician with whom they have a connection or shared world view. A recent study at Vanderbilt University Medical Center demonstrated that having increased knowledge about their doctors affected patients’ satisfaction with their care. Patients were given “biosketch cards” that gave them details about the physicians who were treating them. The cards included a photo of the attending orthopedic surgeon and a synopsis of his or her educational background, specialty, and surgical and research interests. The satisfaction scores of patients who received the biosketch cards were 22 percent higher than those of patients who were not given the cards, according to the study, which was published online Oct. 28 in the Journal of Orthopaedic Trauma. This speaks to the power of a deeper connection between the patient and the physician.

As I witnessed on last night’s Twitter Chat, this is a difficult subject for many physicians – good, ethical physicians. Many take the call for transparency as a personal affront. And this becomes yet another hoop for them to jump through at a time when they’re already having to deal with so many changes and new requirements. Feel free to check out the transcript from last night’s #HCLDR chat on Symplur’s website by clicking on this link. Below are a couple of the statements made by physicians during the chat. You’ll see a range of opinions and perspectives:

“MDs are already losing their status… Sharing finances would be yet another handoff of power. #hcldr”

“Disclosure is common – we do this for membership of professional organizations, meetings. Doing it publicly seems logical #hcldr”

“I think it is very reasonable to disclose a range to organizers. Then decision can be made re potential COI #HCLDR”

“Kickbacks = fraud, but influence is harder to determine need ethics training for docs and legal responsibility #hcldr”

“Agree need to be careful don’t make it too hard to practice medicine #hcldr”

“Do you think disclosure ever cause a pt to refuse a drug which really is the best Rx? #DevilsAdvocate #HCLDR”

“Agree but where does disclosure stop. I am using an EMR that allows me to bill you more?… test, studies, #HCLDR”

“Most doctors are ethical, need to weed out the minority who aren’t not punish the ones who are #hcldr”

“Good point: studies actually show that disclosure does NOT result in pts turning down the right rx #hcldr”

“Is burden on MD to disclose or on patient to ask the right questions? or both. Patients need to be educated. #HCLDR”

“MD’s getting slammed from all sides. Transparency, while good, is yet another slam. #hcldr”

“Disclosing a pharma relationship I am comfortable w/, its saying how much that makes me wary honestly. #hcldr”

“If your doctor can be bought for a pen cup or mouse you need to find another doctor 🙂 #hcldr”

“Dozens of studies show that even little gifts (gifts, pens, lunches) influence prescription habits #hcldr”

“Misconception-> all ethical violations occur by ‘greatly unethical ppl.’ This is y transparency is key. Prevent the unintentional. #hcldr”

“Just because they (drug company) buy lunch doesn’t mean their drug is no good 🙂 #hcldr”

“I will be honest. I am bothered by a general tone in convo that docs can’t B ethical & collaborate with industry. #middleground”

“How do you define “full disclosure” Should I put up a sign that I eat lunch w/reps a couple of times a week? #hcldr”

If you’re interest in learning more about Dr. Wen and her “Who’s My Doctor” movement, here are some links:

What do you think about this movement? I’d love to hear your perspective.

1 comment on “Should Physicians Disclose Potential Conflicts of Interest to Patients?

  1. Rod Neaveill

    Regarding the Tweet: “MDs are already losing their status… Sharing finances would be yet another handoff of power.”

    I didn’t realize the relationship between a physician and patient involved the physician having “power”. I disclose a lot of personal information to my physician. I want to be confident I am sharing my personal information with someone I can trust.

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