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Table of Contents

Think

Assess

 Patient: Autonomy

 Practitioner: Beneficence & Nonmaleficence

 Public Policy: Justice

Conclude

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18. Financial Disclosures

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Is it not also true that no medical practitioner considers or enjoins what is for the medical practitioner’s good, but that all seek the best interests of their patients? The medical practitioner is a ruler of bodies, not moneymakers.
~ Plato

Abstract

Financial disclosures of conflicts of interest are important in the medical field as they affect the medical practitioner’s clinical judgment and can compromise patient trust and informed consent. Failing to provide financial disclosures violates the patient-practitioner relationship and principles of beneficence, nonmaleficence, and justice. Legal and institutional mandates require financial disclosures in medical journals and for Grand Rounds presentations, including a conflict of interest statement for continuing medical education (CME) credit. Practitioners and medical providers must always disclose any financial conflict of interest.

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Think 

[18:1] Financial disclosures are essential as they are a significant source of real and perceived conflict of interest. In the clinical context, a conflict of interest affects the medical practitioner’s clinical judgments and redirects the medical practitioner’s focus from patient-centered to practitioner-centered. The law, institutional policies, medical profession, and moral mandates emphasize the importance of being honest and transparent about any financial interests that might be perceived as a conflict of interest. Financial interests include monetary values or interests that could directly or indirectly affect practitioners’ judgment regarding patient management and professional presentations.

Assess
Patient: 1) Autonomy

[18:2] Patient autonomy is only possible within the context of a patient-practitioner relationship. 

[18:3] Informed consent depends on the patient being able to trust the practitioner with their protected health information (PHI) necessary for the practitioner to provide accurate patient diagnosis, prognosis, and treatment options. Failure of the practitioner to provide financial disclosures of conflict of interest would compromise the patient’s trust in the practitioner’s medical judgments. Without patient trust, the patient will not freely disclose necessary information. 

[18:4] Informed consent is also dependent upon the practitioner’s use of protected health information (PHI) to make unbiased judgments on the patient’s diagnosis, prognosis, treatment options, and risks and benefits. Failure to provide financial disclosures of conflict of interest compromises the practitioner’s medical judgments, compromising the patient’s informed consent.

[18:5] Failure to provide financial disclosures violates the patient-practitioner relationship for both the patient and the practitioner, and the patient-practitioner relationship is a necessary condition for patient autonomy (informed consent).

Practitioner: 2) Beneficence & 3) Nonmaleficence

[18:6] Regarding beneficence (do good) and nonmaleficence (do no harm), both principles are violated by the practitioner who does not provide financial disclosures of conflict of interest. A conflict of interest, by definition, is something that can affect the practitioner’s judgment as to what is beneficial or risky for the patient, violating the professional end of the maximization of the patient’s best interests. The patient’s best interests is determined by the patient’s reasonable goals, values, and priorities, not those of the practitioner’s. Practitioners have a professional obligation to be patient-centered, not practitioner-centered. Conflict of interest are influences that shift the practitioner’s focus from being patient-centered to a practitioner-centered focus.

Public Policy: 4) Justice

[18:7] Justice (fair social distribution of benefits and burdens) has resulted in legal and institutional mandates that practitioners provide financial disclosures when these are considered to be a conflict of interest. Ignorance of the law or institutional policies is no excuse.

[18:8] All publications in medical journals and all Grand Rounds presenters must also disclose relevant financial sources and conflict of interest. There is a strong correlation between conscious and unconscious biases related to the selection and interpretation of data. For any Grand Rounds presentation that provides continuing medical education (CME) credit, it is required that there is a slide that says that there is no conflict of interest and that a no conflict-of-interest statement is verbally communicated by the person who introduces the speaker or by the speaker themself. After the continuing medical education (CME) Grand Rounds, the survey will ask the participant who is getting the continuing medical education (CME) credit to verify that the conflict of interest and financial disclosure was either affirmed or denied.

Conclude

[18:9] It is always required that a practitioner or medical-provider disclose any financial conflict of interest. For Grand Rounds, there must always be a conflict of interest and financial disclosure, either affirming or denying, for any presentation intended for continuing medical education (CME) credit.

[18:10] In summary, practitioners and medical providers must always disclose any financial conflict of interest to uphold the principles of medical ethics and maintain trust within the patient-practitioner relationship. This transparency is required for publications in medical journals and Grand Rounds presentations, particularly when continuing medical education (CME) credit is involved. By disclosing financial conflicts of interest, medical professionals can ensure that their focus remains patient-centered and that the best interests of their patients are prioritized.

(See also: 9. Conflict of Interest, 21. Gifts, 28. Life-Long Learning, 46. Self-Treatment & Family-Treatment, and 47. Sexual Boundaries)

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18. Review Questions

1. Conflict of interest:

2. Failure of the practitioner to provide financial disclosures of conflict of interest compromises the patient’s trust in the practitioner’s medical judgments. Without patient trust, the patient will not freely disclose necessary information.

3. Failure of the practitioner to provide financial disclosures of conflict of interest may compromise the practitioner’s medical judgments, compromising the patient’s informed consent.

4. A conflict of interest violates the professional obligation of beneficence (do good) and nonmaleficence (do no harm) by changing the practitioner’s focus from being patient-centered to practitioner-centered.

5. There is no correlation between conscious and unconscious biases related to the selection and interpretation of data.

6. Every Grand Grounds presentation that provides CME credit must have a conflict of interest notice.

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18. Clinical Vingnettes

1. Mr. Alijah Johnson, a 62-year-old male help desk analyst to your clinic complaining of chest pain and shortness of breath. The patient has a history of coronary artery disease and has previously undergone percutaneous coronary intervention. The patient is accompanied by a pharmaceutical company representative promoting a new drug for the treatment of coronary artery disease. Which of the following best describes the situation regarding the presence of the pharmaceutical representative during the patient's visit?

2. Ms. Zoey Jenkins, 48-year-old cloud computing specialist is seen in a clinic for a routine follow-up visit. During the visit, the patient expresses concerns about the financial relationships the practitioner may have with pharmaceutical companies. What is the most appropriate response by the practitioner?

3. Ms. McKenzie Parker, a 52-year-old civil engineer visits a medical practitioner for a diagnosis and treatment plan. The practitioner needs access to the patient's protected health information (PHI) to provide the best care, but the patient is concerned about the financial disclosures of the practitioner and wants to know if there are any potential conflicts of interest. What is the most important factor for ensuring that the patient is willing to disclose PHI?

4. A practitioner is approached by a pharmaceutical company to participate in a clinical trial for a new drug. The practitioner is offered a large sum of money to enroll patients in the trial and report the results. How does the financial conflict of interest violate the practitioner's professional obligations?

5. A practitioner gives a Grand Rounds presentation on a new medical device. The institution requires all Grand Rounds speakers to disclose any financial conflicts of interest before the presentation. What is the correct method for fulfilling the requirement for financial conflict of interest disclosure?

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18. Reflective Vignettes


1. Ms. Sarah Johnson, a 65-year-old retired school teacher, comes to the clinic complaining of dizziness, fatigue, and shortness of breath. Upon examination, the practitioner suspects she may have a slow heart rate and requires a pacemaker. The practitioner recommends the company that they believe has the best pacemaker on the market, which coincidentally has been donating funds for educational purposes for medical professionals at the institution where the practitioner works. The differential diagnosis includes aortic stenosis, heart block, and sick sinus syndrome. The practitioner discusses the options with Ms. Johnson and together they decide to proceed with the pacemaker implantation.

Think

Assess

  Patient: Autonomy

  Practitioner: Beneficence & Nonmaleficence

  Public Policy: Justice

Conclude

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2. Mr. John Smith, a 45-year-old construction worker, is referred to the practitioner for evaluation of chronic lower back pain. The practitioner orders an MRI, which shows a herniated disc at L5-S1. The differential diagnosis includes discogenic pain, spinal stenosis, and facet joint syndrome. During a Grand Rounds presentation, the practitioner presents a study on a new pain medication without disclosing that the pharmaceutical company provided the research subjects and published the data in their in-house journal. This omission raises concerns about potential conflicts of interest and the validity of the study's findings.

Think

Assess

  Patient: Autonomy

  Practitioner: Beneficence & Nonmaleficence

  Public Policy: Justice

Conclude

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