Transparency and the Doctor–Patient Relationship

Recently, I read an article in the New England Journal of Medicine, “Transparency and the Doctor–Patient Relationship — Rethinking Conflict-of-Interest Disclosures,” by Eli Adashi from Brown University, I. Glenn Cohen from Harvard University, and Jacob Elberg from Seton Hall University.

The article started with the story of a March 2020 U.S. Department of Justice lawsuit against a major manufacturer of spinal-surgery devices and related entities, accusing the company of paying nearly three dozen spine surgeons a total of more than $8 million in sham consulting payments.

I’ve thought a lot pharmaceutical and device companies over the years, and agree with the authors that we must reduce the harm associated with improper financial relationships between manufacturers and physicians. I do believe that clinicians could be required to disclose such relationships directly to patients. Cases of improper financial relationships between manufacturers and physicians not only harm patients, but also threaten the doctor patient relationship. Trust is so important in health and healing.

The main issue I see is a nuanced discussion of disclosures between doctor and patient would take time. Extra time would need to be built into clinic schedules to discuss these complex issues. Who would pay for this time? It’s doubtful the private insurance companies would pay. This might fall on the back of already overburdened doctors and patients.

A second issue is of health literacy and science literacy. Many patients don’t have a high educational level and don’t speak English. Would disclosing to every patient be feasible in a busy clinic day? If we had a single payer/ Medicare-for-all, this situation would be different. There would be more time to talk to patients about these issues.

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