How transparent should doctors be with their patients?
Dr. Leana Wen wants her patients to know she was born in Shanghai, China, that she has no kids but would love to someday, and that she drinks the occasional glass of wine. She believes such transparency -- along with a full disclosure about how she earns her paycheck -- is a must for keeping doctors honest and helping patients get a sense about how their doctor’s personal views and financial interests factor into the care they receive.
On a new website she launched in the spring called Who’s My Doctor, Wen wrote in her profile that she receives 55 percent of her annual income from her clinical practice at the George Washington University Emergency Department in Washington and doesn’t get paid based on how many tests she orders or procedures she performs. She also disclosed the sources of her research funding and which hospitals and patient advocacy groups have paid her to give speeches.
“I think patients want to know if their doctor is salaried at a hospital or is fee for service, meaning that the doctor gains financially every time a procedure or test is performed in the office,” said Wen, who recently left Boston where she was an emergency medicine resident at Brigham and Women’s Hospital. They may also want to know their doctor’s position on abortion or comfort level in treating transgender patients, she added.
Massachusetts state law prohibits drug and device manufacturers from providing expensive gifts -- like free trips to golf resorts -- to doctors who prescribe their products, and a new state law requires doctors to disclose the cost of treatments when asked. Wen, however, would like to see even more transparency practiced by doctors.
How much, though, do patients really need to know? Johns Hopkins internist Dr. Zackary Berger revealed on his profile that he’s Jewish and a Democrat. Dr. Tanner Caverly, a Unitarian, also described his work philosophy: to strive to practice in a way that meets the demands he places on physicians who treat his own family members.
“Disclosure about financial conflicts is one thing, but trying to put into words a physician’s philosophy on medical care is more complicated,” said Dr. Joshua Kosowsky, vice chair and clinical director of Brigham and Women’s Hospital’s emergency department, who co-authored the book When Doctor’s Don’t Listen with Wen.
“Feelings about rational care to curb unnecessary medical costs and end of life issues are important principles that doctors should be discussing with their patients,” Kosowsky said, but it should go beyond the few sentences written on a web profile.
While he applauds Wen for her efforts to get doctors to be more transparent, Kosowsky hasn’t posted a profile on the site -- only 30 physicians have so far -- since he said it wouldn’t serve much purpose. His patients don’t get to choose whether or not he treats them in the emergency department.
Dr. Aaron Stupple, an internal medicine resident at Beth Israel Deaconess Medical Center, said he put a profile on Who’s My Doctor to start a conversation with his patients. Some may ask, for example, whether his philosophical concerns about an “overuse of health care resources” will mean that he may be less likely than other doctors to order an MRI for their back pain.
“I’m trying to give patients a general sense of my philosophy,” Stupple said. “It’s easy to talk the talk, but it’s different when you make the commitment to be transparent. It’s a bit more honest.”
He and more than 300 other health care providers signed a “transparency manifesto” on the site stating that they believe a patient’s informed consent isn’t given “without doctors’ disclosure of how their financial incentives align with their treatment recommendations” and that “patients have a right to know” their doctor’s views on issues like end-of-life care, integrative medicine, and shared decision-making.
In a TEDMED speech Wen gave Thursday in Washington before 5,000 policymakers, health consumers, and doctors, she attempted to make her case for why greater transparency was so important by discussing her own mother’s experience several years ago with advanced breast cancer.
“When my mother had breast cancer, we looked up her oncologist and found that he was a spokesperson for the pharmaceutical company that made the chemotherapy regimen that he had prescribed for her,” she said. “Such a conflict meant we had no way of knowing whether this was actually the right regimen for her.”