Teaching hospitals have been writing conflict of interest policies covering research and corporate relationships, but they also should set rules for disclosing physicians' clinical conflicts that can bias patient care, according to an Association of American Medical Colleges (AAMC) report released Wednesday.
"Less than 1% (of teaching hospitals) have adopted policies that define and address conflict of interest in clinical care," said AAMC chief health officer Joanne M. Conroy, MD. "This report is the first step in providing guidance on how these institutions can develop policies."
Asked for an example of what sorts of conflicts these policies should cover, Conroy answers:
"Let's say you're having a hip replacement, and the orthopedic surgeon you're meeting with actually was the inventor of one of the most commonly implanted hips in the U.S. He probably needs to disclose that to you if that's part of the discussion of what kind of hip you're going to receive."
She added, however, that there are other questions the policy should address. "Does he disclose how much he makes from royalties from that company over a period of time or for your individual procedure?" Likewise, she said, if the doctor had a part in the development of a drug or medical device from which he or she receives royalties or fees, that should be disclosed, too.
The AAMC report, "In the Interests of Patients. Recommendations for Physical Financial Relationships and Clinical Decision Making" is the third in a series that AAMC task forces have produced regarding conflicts of interest in medical schools and teaching hospitals. It includes seven recommendations for medical institutions to address the issue.
Prior reports examined industry funding of medical education and financial conflicts of interest in clinical research.
While the report is careful to say that some relationships between clinicians and for profit companies are often necessary and beneficial, there are perceived if not actual conflicts of interest that must at the very least be disclosed.
"The interests of the patient are at stake, as is the trust of the public," the report's introduction says. "Moreover, when personal financial interests conflict with clinical care activities, there is the potential for a negative and lasting influence on the development of professionalism in medical students and other trainees."
Conroy said that three institutions to her knowledge are developing or have such policies in place, such as the University of Washington in St. Louis, the Mayo Clinic and the Cleveland Clinic. But academic medicine needs to adopt this as an institutional priority not just for the 300,000 medical students, residents and practicing faculty members, but to set a model for private practice doctors as well.
"Advances in medicine depend on a constructive partnership between academic medicine and the pharmaceutical, device and biotechnology industries," the report says. "At the same time some of these interactions have been shown to produce both potential and actual conflicts of interest, especially when the relationships have the capacity to generate financial gain for physicians and their institutions and influence professional behavior."
One burgeoning hot topic involves potential conflicts between physicians and the relationships they and their hospitals develop as they adopt new models in health reform, such as accountable care organizations, medical home models and bundled payment systems.
"As these payment methodologies roll out we will be looking at the unintended consequences," Conrad says. We're going to learn a lot over the next five years." For example, Conroy says physicians and hospitals creating accountable care models will want to partner with high quality organizations to provide a continuum of care.