Published 5/1/2010
Terry Stanton

Patients put trust in physicians

Many believe industry relationships are appropriate

A survey of patients who had undergone procedures for instrumented spinal fusion or total joint arthroplasty found that a large majority believe surgeon-industry relationships with regard to implants are beneficial and appropriate. The survey also indicated that most patients believe that their surgeon will choose the best implant for them.

The results of the survey were reported in the paper “Patient Perceptions of Surgeon-Industry Relations,” presented at the 2010 AAOS Annual Meeting by Scott C. McGovern, MD.

Dr. McGovern and colleagues surveyed 1,000 patients matched by demographics, diagnosis, and either of the two implant procedures. Surgery patients were matched with cohorts of nonsurgical patients with correlating diagnoses during the same period. The responders had a mean age of 66 years, and 51 percent were men. Spine patients comprised 42 percent of the group, and the remainder was in the knee and hip category.

“While it is evident that collaboration between surgeons and industry may be beneficial and essential to the delivery of quality health care,” said Dr. McGovern, “the perceptions of our patients must be recognized to maintain trust as a patient advocate.”

Implant selection
In most cases, responses from the surgical and nonsurgical patients did not differ significantly; for example, 96 percent of surgical and 94 percent of nonsurgical patients said they trusted their physician’s choice of implant. When asked about whether a physician’s choice of implant is based on personal financial gain, three out of four patients disagreed. A large majority—85 percent—said they think their doctor chooses implants based on either familiarity and personal preference or medical research.

Few patients—7 percent of those in the survey—believe that hospitals or insurers should have the sole choice of implant, Dr. McGovern reported. More than half (56 percent) believe physicians should have the sole choice of implant, while about one quarter (26 percent) think that the patient should have the sole choice.

Most responses trended toward trust in the physician. More than 8 out of 10 patients in the survey agreed that their doctor really cares for them as a person and that their doctor is considerate of their needs.

Industry payments
Although only 40 percent of patients believe that physicians should receive financial reimbursement for an advisory role alone, most (82 percent) believe that doctors should receive payment for designing implants. A small proportion (10 percent) thinks that surgeons should receive additional payment for each implant used, according to the survey. When asked to determine the method and value of compensation, surveyed patients did not indicate any consensus, but 30 percent did reply “market rate.”

“Another salient finding,” wrote the authors, “is that only a minority of patients believes that physician reimbursement increases overall healthcare costs.”

Approximately one-third of patients surveyed believed that physicians should help promote the implants they helped design. Just under one quarter think that private companies should advertise directly to consumers, but 65 percent think that private companies should be able to advertise directly to physicians.

Patients are, however, aware of the need for disclosure. Most patients—particularly those who have not had prior surgeries—agreed that physicians should tell patients about a financial or advisory relationship with industry. “There is a clear concern among patients for physician-owned device companies,” said Dr. McGovern.

The great majority of surgical respondents (91 percent) tended to trust their doctor to put the patient’s needs above all other considerations; this result compared with 83 percent of nonsurgical patients (p = 0.03).

Summing up the study, Dr. McGovern said, “The vast majority of patients in this survey indicate that physician relationships with industry are acceptable and improve their health care. They trust their doctors to advise their medical decisions appropriately. Surgeons must ensure that potential conflicts of interest are managed in a transparent and ethical manner to preserve this trust.”

The co-authors of “Patient Perceptions of Surgeon-Industry Relations” are Robert T. Trousdale, MD, and Bradford L. Currier, MD.

Disclosure information: Dr. McGovern—no conflicts; Dr. Trousdale—DePuy; Dr. Currier— DePuy, Synthes.

Terry Stanton is senior science writer for AAOS Now. He can be reached at tstanton@aaos.org