Sunshine Act: Are Doctors Still Enjoying Free Lunches From Drug Reps?

Leigh Page

Disclosures

November 21, 2017

In This Article

Do Patients Care?

Patients have shown a surprising lack of interest in the Open Payments website, considering that it was chiefly intended for them to use.

The site breaks down information on each doctor into 16 categories, such as food and beverage, education, consulting, and research. In 2017, it added a tool that allows users to compare a particular doctor's level of payment with the national average or the average within the doctor's specialty.

Only 5% of the public is aware of the website, according to an as-yet unpublished study obtained by the Chicago Tribune[20] in August 2017. Tribune reporters who asked patients about the site met with blank stares. However, CMS reported[21] almost 1 million visits just in the first 3 months of the site, so some patients must be using it.

When patients have payment information on their doctors, do they bring it up to their doctors? Only one third of patients said that they would probably ask their doctors about potentially troubling financial ties, according to a 2007 finding by the Pew Prescription Project, cited in an article[22] in the Washington Post.

Bringing up this information is "a genuinely difficult and awkward conversation to have," the director of the Pew project told the Post. "Patients are very averse to getting into antagonistic relationships with doctors," added an AARP official.

Patients Want to Discuss Their Health

In addition, Sullivan notes that patients have limited time with their doctor, and they would rather discuss their health. Also, they probably don't think they can change their doctor's opinion. "If they bring it up," he says, "what difference is it going to make?"

If a patient challenges a doctor and the doctor refuses to drop the relationship, would the patient leave the practice? Patients have to cross two substantial hurdles before they would do so, according to Genevieve Pham-Kanter, a Harvard ethicist, in a 2014 paper.[23]

First, she wrote, they would have to be "sufficiently repelled at the thought of a doctor receiving payments," when quite often they are probably just curious. Then they "must lose faith in the doctor's judgment," which is unlikely for patients who have had a long-term relationship with the doctor.

What upsets patients about payments would probably surprise many physicians. Patients get upset about free meals and trips but not about much larger payments for consulting about drugs and devices, according to a 2014 study.[24] Whereas meals didn't seem to have any use as far as patients were concerned, large consulting fees "were seen as signaling physician expertise," the authors wrote.

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