I am a little late to this, but a friend of mine recently shared Dr. Leana Wen's TED Talk "What your doctor won’t disclose" from September 2014. I recommend you view the video which is about 15 minutes long, or if you're more of a reader, here's a link to the transcript.
Dr. Wen is an accomplished physician, writer, and public health professor. She is the author of When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests, founder of Who's My Doctor, and currently serving as Commissioner of Health in Baltimore City. I looked Dr. Wen up after watching her TED Talk and found it amusing how many similar experiences we share - Chinese immigrant who dreamt of becoming a physician, the memory of being told to "go back to my country" when in fact I hold an American passport, heck we even attended Washington University in St. Louis during the same time period! I was an undergrad there when she was in medical school. But that's really neither here nor there.
Here is my take on Dr. Wen's TED Talk.
- Doctor-patient relationship in America has deteriorated due to an erosion of trust.
- This lack of trust is caused by the patient's increasing inability to relate to or "know" his/her doctor.
- How doctors are paid is a big part of what the patient doesn't "know" and would need to know to "trust" his/her doctor again.
- Therefore full financial disclosure by the doctor may lead to rebuilding of that critical patient-doctor trust.
My opinion: well, mostly criticisms, because simply agreeing with everything Dr. Wen said would make for a very boring read...
- The total transparency approach really only applies to the non-emergent clinical subspecialties such as internal medicine, oncology etc. We can probably agree it would be rather strange for your radiologist or pathologist to attach an addendum to every report describing exactly how he/she is paid. And outright absurd for an ER or ICU physician to drag you or your family aside to "disclose" during an emergency situation.
- In this world of industry-sponsored medical miracles, it will going to be difficult for one to participate in research and pursue academic medicine without developing any ties to the medical-industrial complex. We are already required to disclose when it comes to academic medicine and research. To go further and disclose every fine detail to the patient in the clinical setting may lead to unnecessary doubt on your intentions when in fact, your life-saving invention would not have been possible without industry sponsorship.
- Medicine in real life is scary. Anyone with clinical experience will realize that despite the push for evidence-based-medicine, the majority of medicine is not evidenced based. Partly because it's costly to answer these questions (the average drug developed by a major pharmaceutical company costs at least $4 billion) and partly because there are simply some questions we cannot answer without violating our humanity. For example, how do you answer the question - "how much of a drop would it take to cause permanent brain injury in an infant?" So if patients really do find out "what medicine is all about," would they really trust us more?
- Finally and this is probably my biggest issue with the talk. The trust that Dr. Wen speaks of is one-directional, she's advocating for doctors to disclose fully to gain the trust of the patient. But in order for total transparency to work - you also need to trust your patients, 100% of them. Your finances are very personal and to disclose without reservation would require you to trust everyone who will have access to that information. To make an analogy, you could share your social security number with all of your friends, but if even one of them turn out to be less of a "friend", you may very well end up a victim of identity theft. So, how much do you trust your patients?
What is your take on Dr. Wen's talk and her proposal of total transparency? Let me know in the comments!