Conflict of Interest and the Doctor

There is consensus within the United States that the ideal relationship between a physician and his/her patient is one of an equal partnerhip. Equal in the sense that there is a common goal to promote relief and cure the illness and each side contributes toward attempting to accomplish that goal. The physician brings his/her medical knowledge and skills. The patient brings the history, views, wishes and the final decision-making capacity. In other countries and cultures, the physician may still assume a greater role. In any event, there must be cooperation on both sides and there must be trust.

The issue of paternalism by the physician is just one issue which can affect the function of this relationship. Another issue facing the physician for which he/she must consider in order to maintain the trust within a fiduciary relationship to the patient is that of conflict of interest. The physician has a responsibility and duty to always decide and act in the best interest of his/her patient. However, there are potential conflicts of interest which can affect this duty. Some conflicts are related to the physician's personal life and some related to external influences. Consider the conflict between the physician and his/her responsibilities to family vs the patient. An example might be a physician delaying treatment of a patient because of need to attend to a family activity. Examples of external influences may include bias or undue influence by pharmaceutical company prescription drug "education" sessions including gifts or in fact, the physician's financial interest in a pharmaceutical company or in development of a procedure. This may lead to conscious or unconscious decisions in, for example, approaches to drug therapy which might not necessarily have been the best for the patient and probably wouldn't have been selected if the influences had been absent.

The physician must be constantly aware of the potential for conflict of interest and attempt to avoid or try to resolve those conflicts which can degrade the patient's necessary need for trust in his/her doctor.