These two papers put together provide the patient experience impact of financial ties to industry as well as the physician willingness to disclose them.
In a previous post, I wrote about what physicians-in-training ask patients when they are admitted to the hospital (not enough). These papers are about what physicians tell their patients about their financial ties, their prognoses, even medical errors. The answer is the same – not enough.
In Iezzoni, et. al, a cross-specialty survey of 3,500 physicians with good response rate, was done, with this conclusion:
Overall, approximately one-third of physicians did not completely agree with the need to disclose serious medical errors to patients, almost one-fifth did not completely agree that physicians should never tell a patient something untrue, and nearly two-fifths of physicians did not completely agree that they should disclose their financial relationships with drug and device companies to patients.
I spoke to author Lisa Iezzoni about the study and her findings yesterday, with a specific focus on the role of patients. She connected me with the Wolston paper, written by a patient about her experience as a multiple sclerosis patient receiving care from a neurologist with financial ties:
I knew that I had felt pressured to take medications by my neurologist. When I found that he had been paid large sums of money—six times my yearly salary—to work for the manufacturers of those same drugs, my loss of faith was complete. I never returned to his neurology clinic again.
Most patients don’t have the resources, including the sense of empowerment, to ask questions and collect data, and we talked about how this will hopefully change, with a demographic shift, as well as greater data transparency.
One such resource is Dollars for Docs, that lists payments to physicians. I call it “the database I am not listed in and never plan to be” . As I was speaking to Lisa, I realized the reason why I support full transparency. However, it’s not that I support transparency, I support freedom from conflict of interest (see my conflict of interest statement here), and I don’t see how payments to doctors support clear judgement, as the Wolston account demonstrates.
With regard to the issue of disclosing medical errors, I think, again, it is patient involvement that matters. I posted about this excellent article in The Permanente Journal, and will copy again what one physician learned when he was brought together with a family through the Kaiser Permanente health care ombudsman program:
This process of explaining myself, opening me up to colleague scrutiny and patient disappointment, was by no means easy. Nevertheless, I know the price paid was infinitely less than living with the thought I had caused harm to a patient and did nothing to remedy it with a truthful disclosure and a heartfelt apology.
Thereafter, I followed-up with my patient and her family, explaining the systemic changes made to prevent a wrong part from ever being introduced during a surgical procedure.
The definition of underrepresented minorities – it is old and needs updating
The other thing that caught my eye that I am sensitive to were the analyses of “underrepresented minority” physicians in the piece, which are defined as “race or ethnicity other than white or Asian.”
We discussed the fact that even though a question was asked about lesbian, gay, bisexual status on the survey, these were not included in this group or in the analysis. They are not included in the analysis because the numbers of this minority group identified was too small to be analyzed (confirming their underrepresented status). They are not mentioned as part of the group called “underrepresented minority” because this term does not officially include the LGB group, or as Lisa pointed out, physicians with disabilities.
The minorities’ attitudes who were analyzed showed differences that are important. We should not forgo the ability to learn from the diversity of our profession if we want to be the best doctors possible.
What about patient disclosure?
While reading these papers, an interesting discussion started on Trisha Torrey’s blog about “What is a real patient?” In the world of greater patient involvement, disclosure may be important as well. When we recruit patients and families to improve the health system through their experience/perspective, it will be helpful to know what their ties are to the health care system itself. This is not so they can be disqualified, it is so more people can be qualified to have air time when people organize panels called “patient/caregiver perspective. “We are all patients,” while being a great thing to say to equalize professional/patient relationships in the room, is not a substitute for “there is a patient in this room.”
This could be a great addition to the already great resource that SpeakerLink is. It would also demonstrate that patients are modeling the behavior that we expect of our physicians.