November 17, 2013

Can Doctors Operate In Transparency?

My answer would be an emphatic no. Most doctors do not want to operate in total transparency. Most doctors have too much baggage with ties to BIG Pharma and the pharmaceutical representatives they see on a weekly or biweekly basis. Their drug company reps ply them with not so little gifts and financial incentives to prescribe the medications that their companies manufacture. That was the reason for my blog here and saying that this could reduce the overall cost of medicine if these drug reps/doctor relationships ended.

This doctor, Dr. Leana Wen, believes doctors should operate in transparency and this link will take you to her reasons and then to her disclosure. She is getting agreement on some fronts and some strong opposition from many doctors within the American Medical Association (AMA). In addition, some drug company reps and doctors are now gaming the system to reclassify what they receive. They are working to avoid having the money received appear in the government reports under the sunshine law. It is unknown at this time whether they will legally get away with this, but they are trying.

Then we have the doctors that receive money for research, do consulting for the drug companies, and are on the speakers roster for drug companies. Why do many doctors court these conflicts of interest? Because of the reimbursement cuts that Medicare and third party insurers have been handing out for the last two decades.

We all know that our healthcare system is broken and in dire need of reform. We all know the statistics: the U.S. spends $2.7 trillion on healthcare, 30% of which is waste in the form of unnecessary tests and unnecessary treatments. Conflicts of interest are rampant, with 94% of doctors reporting an affiliation with a pharmaceutical or device manufacturing company, and many more insidious influences including salaries being tied to “productivity”. Dozens of studies have shown that these conflicts of interest have a real impact on care, and are a major driver of excessive cost and avoidable harm.

In a time when patients are already vulnerable and scared, patients have become even more afraid that they may not be receiving the right care for the right reasons. Doctors, too, have become afraid of their patients. A lot has been written about the fear of malpractice leading to hiding mistakes and practicing defensive medicine.

This Medscape article helps explain what Dr. Wen is attempting to accomplish and the reactions from other doctors. Some doctors are in favor of her actions and many are opposed. With the government publishing what doctors will be receiving in 2014, it would seem that more doctors would support Dr. Wen's actions, but this is not what many doctors want. Many are even opposing the actions of the government.

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