When we go to our doctor, we like to trust that the medical advice they’re giving us is what’s best for us in their medical opinion. Conflicts of interest can strike at the very heart of this trust.
If your doctor has medical biases that aren’t based on medical knowledge, can you trust anything they tell you? What if they’re hiding conflicts of interest? Trust is central to the doctor-patient relationship, so how can you mitigate these fears?
What are Conflicts of Interest?
First, we need to understand what a conflict of interest is. The Journal of the Medical Association (JAMA) defines a conflict of interest as “a situation in which a person is or appears to be at risk of acting in a biased way because of personal interests.” In the medical field, physicians and other medical professionals develop many non-patient relationships through the course of their careers — such as those with different drug companies, institutions, and even other medical facilities. While these relationships are often built naturally and innocently, they can influence medical decisions doctors may make for their patients, as well as reporting in medical research and other medical decisions. For patients, this influence can lead to unnecessary medical procedures or prescriptions.
Examples of Conflicts of Interest
According to the Health Care Compliance Association (HCCA), there are several types of conflicts of interest that may influence doctors. While patients may be affected by some more than others, it’s worth understanding all the ways that bias can enter into a doctor’s decision-making process. These conflicts are:
- Ordinary financial conflicts — When financial self-interest influences or subverts standard medical or clinical decision-making
- Self-dealing — When a decision benefits the doctor or an associated party (like a family member or friend) at the expense of the organization
- Accepting benefits — When a doctor or medical professional accepts a gift, service, or benefit that may influence either the purchaser’s or provider’s decision-making
- Influence peddling — When the doctor accepts benefits in exchange for influence or preferential treatment
- Using confidential information — When a doctor uses confidential information that was acquired through organizational work for private benefit
- Post-relationship favors — Using confidential information gained through organizational work for private benefit after leaving the organization
- Conflicts of commitment — A doctor’s shared or mutually exclusive organizational commitments
This isn’t a complete list of the ways that doctors have a conflict of interest, but it can give you a sense of where conflicts can arise. For example, one conflict of interest that has been growing in recent years is physician investment or ownership of medical hardware or facilities. These financial connections can influence doctors to encourage services or procedures that may not be fully needed by the patient.
Do Doctors Have to Report Them?
The best way to protect against conflicts of interest is for everyone to be aware of the potential for conflicts, whatever the cause or however innocent the relationship may be. If the patient is aware, they can be more cognizant of how those interests may be influencing the doctor’s decisions. At the same time, if the doctor is aware of how the subtle relationships and interests can touch their decision-making, they can take steps to counteract this influence. If this can be so important, what steps are in place to ensure that doctors report conflicts of interest?
The Physician Payments Sunshine Act of 2007 (PPSA or Section 6002 of the Affordable Care Act) is one such law that requires manufacturers of medicines, medical equipment like DME, and medical supplies to regularly report any and all gifts or financial payments to doctors. The law also requires these parties to report any ownership or investment from doctors that they may have. The Centers for Medicare & Medicaid Services (CMS) see these reports. They then release Open Payments Data to the public.
Allowing conflicts of interest to affect your decision-making (especially if placing personal finances above patient care) is highly unethical behavior.
Outside of legal requirements, professional organizations like the American Medical Association (AMA) hold their members to a high ethical standard. Allowing conflicts of interest to affect your decision-making (especially if placing personal finances above patient care) is highly unethical behavior. Disciplinary action for such unethical actions can include warnings, penalties (up to and including expulsion from the organization), and criminal punishment. The AMA encourages physicians to report unethical behavior, like influential conflicts of interest, that their colleagues may have. Many institutions have their own rules on conflict of interest disclosure, which are essential to maintaining patient trust.
What Can You Do?
If you’re concerned about the influence that conflicts of interest can have on your doctor, whether it’s because you’re unsure if they have any or because you just want to be sure, you can begin to look into it. A good place to start is at CMS’ Open Payments Data. What’s convenient about this site is that it’s updated regularly, every 90 days as mandated by the PPSA, and easy to navigate. Simply type in your doctor’s name to see how much they’ve been given and by who specifically. The sole downside of this is that it’s only for drugs, medical equipment, and supplies. This can cover a large number of potential conflicts, but it won’t necessarily get everything.
If your doctor is evasive or unwilling to share any potential conflicts of interest, you may want to consider finding a new doctor.
It may be uncomfortable, but the best way to learn about conflicts of interest is by talking to your doctor. Your Annual Wellness visit is a good place to check on this. Just ask if there are any relationships or conflicts of interest that you should know about as their patient. If your doctor is evasive or unwilling to share any potential conflicts of interest, you may want to consider finding a new doctor, especially if you feel you can’t trust their medical opinion anymore.
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Trust is one of the key factors of any relationship, but it’s especially important in the one you’ve established with your doctor. You’re counting on their expert opinion to ensure you’re as healthy as you can be. If that trust is broken, it can also be difficult to trust the medical advice you receive. For your own health, it’s critical that you feel confident in your doctor. The potential for conflicts of interest can, and do, arise, but that doesn’t always mean they’ll develop. Talking to your doctor and monitoring conflict disclosures can protect this trust.