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Is There a Conflict of Interest?

Educational Objective
To understand how to respond when observing inappropriate clinical practices carried out by other clinicians.
1 Credit CME

Dr Patel is an internist who recently joined a large multidisciplinary clinic. She often refers her patients to 1 of the 6 cardiologists who work there. She has noticed that when her patients are seen by Dr Wells, they almost always undergo stenting procedures, whereas when her patients are seen by the other cardiologists, a larger variety of treatment approaches are used. At first she thought it was a coincidence or that perhaps she was somehow sending patients with more severe heart disease to Dr Wells. But then a colleague made an offhand comment that “If you want your patient to get stented, send them to Dr Wells.” She is concerned that her patients may have been overtreated and subjected to needless risk and that Dr Wells may not be acting in the best interests of his patients.

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Article Information

Corresponding Author: Wendy Levinson, MD, St Michael’s Hospital, Department of Medicine Research, 250 Yonge St, Sixth Floor, Room 648, Toronto, ON M5B 1W8, Canada (wendy.levinson@utoronto.ca).

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Drs Ginsburg and Levinson report that they have received royalties from a book that is cited in the references. No other disclosures were reported.

References
1.
ABIM Foundation; ACP-ASIM Foundation; European Federation of Internal Medicine.  Medical professionalism in the new millennium: a physician charter.  Ann Intern Med. 2002;136(3):243-246.PubMedGoogle ScholarCrossref
2.
Lo  B, Field  MJ; Institute of Medicine Committee on Conflict of Interest in Medical Research, Education and Practice.  Conflict of Interest in Medical Research, Education and Practice. Vol 1. Washington, DC: National Academies Press; 2009.
3.
Austad  KE, Kesselheim  AS.  Conflict of interest disclosure in early education of medical students.  JAMA. 2011;306(9):991-992.PubMedGoogle ScholarCrossref
4.
Cram  P, Rosenthal  GE.  Physician-owned specialty hospitals and coronary revascularization utilization: too much of a good thing?  JAMA. 2007;297(9):998-999.PubMedGoogle ScholarCrossref
5.
Choosing Wisely. Society for Cardiovascular Angiography and Interventions: recommendations. 2015. http://www.choosingwisely.org/clinician-lists/society-cardiovascular-angiography-interventions-pci-in-asymptomatic-patients/. Accessed March 28, 2017.
6.
Creswell  J, Abelson  R. Medicare payments surge for stents to unblock blood vessels in limbs. New York Times. January 29, 2015. https://www.nytimes.com/2015/01/30/business/medicare-payments-surge-for-stents-to-unblock-blood-vessels-in-limbs.html?_r=0. Accessed February 3, 2015.
7.
Integrity and accountability. In: Levinson  W, Ginsburg  S, Hafferty  FW, Lucey  C, eds.  Understanding Medical Professionalism. New York, NY: McGraw-Hill Medical; 2015:85-115.
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