June 2007 | Back to Table of Contents

MMA Viewpoint

Professionalism, Ethics, and Trust

Strengthening or restoring professionalism is an important issue for Minnesota Medical Association members. In fact, preserving the professionalism of medicine is part of our
mission.

At the core of professionalism are honesty and integrity, a code of ethics and personal application of it. In medicine, this means the patient and the patient’s interests come first, always. But that isn’t enough. Not only should patients come first, they also must know that they come first. That knowledge builds trust, which is at the heart of the patient-physician relationship. Any perception that physicians’ medical decisions are inappropriately motivated by self-interest threatens to erode that trust.

Thus, we were concerned about the impact of a recent article in the Journal of the American Medical Association that reported that at least 14 percent of Minnesota doctors received $100 or more from pharmaceutical companies between 2002 and 2004 for conducting educational sessions, advising on research, serving on advisory boards, and performing other services. An accompanying editorial stated that, while pharmaceutical companies have made profound contributions to medical therapy and public health, their marketing techniques have created growing public and professional mistrust.

Since the JAMA article was published, we have seen headlines that call our objectivity into question: “Weed out conflicts in prescription drugs,” “Doctor, drug industry relationship under scrutiny,” and, most recently, “Where money and medicine intersect, room for questions.”

What can we do to avoid mistrust? Drug companies and physicians cannot be separated. Physician participation is required for research and clinical trials. Physicians need to be informed about drugs. But important issues need to be addressed: How should drugs be promoted? Who should promote them? How should physicians obtain information about drugs? Should physicians only get information from impartial sources? Which sources are impartial? Should drug companies not be permitted to advertise at all?

The relationship between physicians and drug companies isn’t the only one that can chip away at trust. Other relationships may be perceived as conflicts of interest as well. For instance, there have been allegations of physicians receiving kickbacks from medical device companies for use of certain stents or prostheses. Health plans claim that physicians who own imaging devices overuse them. The government examines physician ownership of certain facilities for evidence that profit sharing might be payment for referrals in disguise.

We need to be acutely aware of how the public and our patients may perceive our relationships. We need to be actively concerned that any arrangements we have pass the smell test.

To help physicians avoid conflicts of interest related to prescribing, the MMA and the AMA have adopted policies on pharmaceutical company payment to physicians. We’re now asking whether these policies are sufficient or whether we need more guidance (see p. 23). The MMA Committee on Ethics and Medical-Legal Affairs will review our policies and possible needs and report their recommendations to the MMA Board of Trustees.

The bottom line is this: To preserve the professionalism of medicine, any conduct that has even the potential to appear to conflict with our patients’ best interests needs to be examined very carefully. If our patients don’t trust us, we are powerless to help them.