Last week I was on several flights as I traveled for a work trip which turned out to be much-shorter than anticipated. Without access to WiFi (at least not that I was willing to pay for), it was a great time to catch up on podcasts I often listen to while I am at the office. One of the podcasts I listened to was the TED Radio Hour podcast on Courage. The show had a profile of several different people who were profiled for their courageous activities, and asked to discuss what courage meant to them.
One of the profiled guests was Dr. Leana Wen, an emergency physician and patient advocate who created a website called Who’s My Doctor?, which is a website dedicated to total transparency between doctors and their patients. Doctors on the site disclose not only the basics about their medical degrees and specializations, but also about how they get paid and their beliefs about things like women’s reproductive health and end-of-life care. The idea for the website was inspired when Dr. Wen’s mother, who was undergoing treatment for breast cancer, looked up her oncologist on the internet and discovered that he was a paid speaker for the drug company that made her chemotherapy regimen. Instantly, her mother began to wonder whether the doctor’s recommendation for her treatment was coming from his knowledge and experience, or whether it was the result of his relationship with the drug company.
The reason Dr. Wen was profiled on the TED Radio Hour that focused on Courage was because of the backlash that she received after she started the website. She profiles just some instances of the backlash in the first few minutes of her 2014 TEDMed talk:
They told me that I’m a traitor to my own profession, that I should be fired, have my medical license taken away, that I should go back to my own country. My email got hacked. In a discussion forum for other doctors, someone took credit for “Twitter-bombing” my account. Now, I didn’t know if this was a good or bad thing, but then came the response: “Too bad it wasn’t a real bomb.”
Setting aside the disgusting reaction that Dr. Wen received, her TEDMed talk does bring up some valid points that many in the medical field are ashamed to admit, based on the violent reaction to Dr. Wen’s transparency pledge. Dr. Wen points out that in decades past, you knew who your doctor was, because he was a member of your community. You saw him/her at school functions, at the grocery store, and everywhere else. But now, it is a very different environment. Not only is it a good possibility that you won’t know who your doctor is, the odds are also good that not only is your doctor receiving money or other gifts from drug/device manufacturers, but that you won’t know how your doctor feels about very important issues until it’s too late.
As an example of the latter, Dr. Wen describes how her mother signed advanced directives AND wrote a 12 page document, which she gave to her family, insisting that her life not be prolonged through extraordinary measures. When her mother went into ICU and the doctors said that she needed to be intubated, Dr. Wen spoke up and said that this was against her mothers wishes, and they had the documents to back it up. Not one, but two doctors who were there not only refused to accept the decision, they actively tried to manipulate Dr. Wen and her family to act against their mothers stated wishes. In a case like that, what good is the advanced directive? If the doctors refused to follow what the patient wants, even if there are signed legal documents, then why do we bother to give the patients the illusion that they have a choice in their medical care? It would be far more effective to just call reality what it is and say, “No, you don’t get to chose that. Your doctor will make the call because you aren’t qualified”. In a situation like that, as a patient you need to know that the doctor is on your side. If you are battling a terminal illness and make the decision you don’t want extraordinary measures taken, it is imperative that you know ahead of time if your doctor doesn’t believe a patient should have that choice, so that you can find a doctor who will treat you the way you want to be treated by a physician.
Then there is the cost issue. News emerged last week that the American Medical Association has called for a ban on drug advertising to consumers, with their stated purpose being to reign in the costs of prescription drugs by getting rid of the “millions of dollars” that drug companies spend on these advertisements. It’s an idea that I welcome, because it does indeed seem like a waste of money. But in reality, the money companies spend on direct to consumer advertising is dwarfed by the money they spend on ads and other methods to target doctors. All of the free lunches, free trips, office swag and trips by drug reps to clinics big and small to convince the doctor that one company’s version of a drug is a far better option than another drug or another treatment method.
Does all of this direct to doctor advertising sway a doctor’s treatment decisions? Maybe it does in some cases, and maybe it doesn’t. But trust is a fragile thing, much like the reputation of a Victorian Lady. An impropriety doesn’t have to have occurred in order for irreparable damage to have occurred. As Dr. Wen points out, if you are seeing a doctor for back pain you as the patient should have the right to know whether your doctor is getting paid $2500 to recommend surgery and $25 for recommending physical therapy, or whether they are getting paid the same for both recommendations. I know that I want to know that about my physician, because it will help me ask the right questions to be proactive about my healthcare.
I highly recommend no only watching Dr. Wen’s TEDMed Talk, but also advocating for transparency in medicine. With the focus switching to patient-centered care, I have a feeling this issue is going to be front and center.