“Under no circumstances may physicians place their own financial interests above the welfare of their patients.” American Medical Association Code of Medical Ethics Opinion 11.2.2.
Doctors rightly occupy a privileged position in our society. We entrust them with our bodies, our health and, indeed, our very lives. We trust them to put our interests first. We trust them not to take advantage of us. We trust them to be honest with us. Without this level of trust, the physician/patient relationship cannot work. Sadly, it seems that more and more often doctors are putting their own interests ahead of ours. We need to be aware of this and to take it into account in our dealings with our doctors. To do otherwise is foolish and naive.
There are many ways in which a doctor can have a conflict of interest and the possibilities are increasing all the time. Conflicts vary in terms of their influence and effect on the conduct of the doctor. However, even when the doctor does not believe that the conflict is having any effect on her decision making, studies show it usually is.
Here are some conflicts of interest you should be aware of and take into account in your dealings with your doctor.
- Relationships with pharmaceutical companies. These can come in many flavors. Representatives of pharmaceutical companies go from doctor office to doctor office meeting with doctors and handing out drug samples. They take doctors to lunch or dinner. They may give the doctor gifts. The companies themselves hire doctors to speak at meetings or to advise the company on this issue or that. Some doctors partner with pharmaceutical companies to develop new products. The one thing all of these relationships have in common is that they are likely to play a role when it comes time for the doctor to decide whether to order a specific drug or whether to recommend a particular drug regimen. Certainly, the drug companies believe in this effect or they would not be spending the amount of money they do trying to influence doctors.
- Relationships with financial firms. Some doctors have partnered with financial firms to “assist” their patients in getting financing so they can afford the services the doctor provides. This occurs most often in the cosmetic surgery field where the patient’s health insurance doesn’t apply and the patient has to pay for the procedure on his or her own. The doctor’s staff will sometimes help patients with the application process. The interest rates charged by these companies may be much higher than what the patient could get on the open market. The doctor may get a fee for every patient who signs up for a loan.
- Relationships with manufacturers. We live in an age of prostheses. Surgeons often use hardware, which they place in our bodies. These range from stents to keep coronary arteries open to spinal hardware to the hardware used in knee and hip replacements. Some surgeons buy the hardware they are going to place in their patients directly from the manufacturer. They then sell it to the hospital at which they are going to operate. This purchase and sale by the surgeon can add many thousands of dollars in income for the surgeon from a given procedure. Researchers have consistently found that surgeons who have these companies and have a financial interest in the hardware they use, place far more hardware than their colleagues who don’t buy and sell hardware. This is not a coincidence.
- Relationships with treatment centers. Doctors may have a financial interest in the treatment center to which they send their patients for certain therapies or for surgery. If they have such a financial interest, they tend to send more patients for these therapies or surgeries than do their colleagues who do not have the same financial interests. One documented example was reported by the Wall Street Journal when it studied urologists who invested in expensive radiation machines for treating prostate cancer patients. Those urologists who bought the machines were much more likely to order use of the machines for their patients than urologists who did not own the machines. Again, this is not a coincidence. These doctors have made a large investment and want to get their money back and to make a profit to boot.
- Financial interest in the procedure to be performed. There are many medical conditions which can be managed either with medical therapy or with surgery. When you go to see the surgeon for a surgical consult, keep in mind that the surgeon gets paid for performing surgery. She has a financial interest in recommending a surgical approach to your problem. Study after study has found that surgeons perform many procedures that are not medically necessary and that could be handled as well or better by medical treatment. This conflict on the part of the surgeon does not mean that surgery is not the best option for you. It only means that you should be a critical listener and get a second opinion, preferably from someone without a financial interest in your decision.
- Relationships with hospitals. Hospital chains have been buying physician practices and the trend is accelerating. When your doctor works for a hospital chain, she or he may be encouraged to send you to one of the chain’s hospitals for treatment or to therapy centers owned by the chain. The hospital chain expects to increase its business and its profits by purchasing these doctor practices or it would not be opening up its wallet to buy them.
As President Ronald Reagan famously said, “Trust but verify.” Ask questions of the doctor about conflicts. Use the federal government site that shows payments from drug companies and manufacturers to doctors. https://www.cms.gov/openpayments. Remember that doctors are business people who are selling you a service. Just because a doctor said it does not make it true.