Patient views on financial relationships between surgeons and surgical device manufacturers

Patient views on financial relationships between surgeons and surgical device manufacturers

Can J Surg 2015;58(5):323-329 | PDF

Mark W. Camp, MD, MSc; Allan E. Gross, MD; Martin F. McKneally, MD, PhD

Abstract

Background: Over the past decade, revelations of inappropriate financial relationships between surgeons and surgical device manufacturers have challenged the presumption that surgeons can collaborate with surgical device manufacturers without damaging public trust in the surgical profession. We explored postoperative Canadian patients’ knowledge and opinions about financial relationships between surgeons and surgical device manufacturers.

Methods: This complex issue was explored using qualitative methods. We conducted semistructured face-to-face interviews with postoperative patients in follow-up arthroplasty clinics at an academic hospital in Toronto, Canada. Interviews were audiotaped, transcribed and analyzed. Patient-derived concepts and themes were uncovered.

Results: We interviewed 33 patients. Five major themes emerged: 1) many patients are unaware of the existence of financial relationships between surgeons and surgical device manufacturers; 2) patients approve of financial relationships that support innovation and research but are opposed to relationships that involve financial incentives that benefit only the surgeon and the manufacturer; 3) patients do not support disclosure of financial relationships during the consent process as it may shift focus away from the more important risks; 4) patients support oversight at the professional level but reject the idea of government involvement in oversight; and 5) patients entrust their surgeons to make appropriate patient-centred choices.

Conclusion: This qualitative study deepens our understanding of financial relationships between surgeons and industry. Patients support relationships with industry that provide potential benefit to current or future patients. They trust our ability to selfregulate. Disclosure combined with appropriate oversight will strengthen public trust in professional collaboration with industry.

Résumé

Contexte : Ces 10 dernières années, la mise en lumière de relations financières inappropriées entre des chirurgiens et des fabricants de matériel chirurgical a remis en doute la capacité des chirurgiens à collaborer avec les fabricants et ébranlé la confiance du public en la profession. Nous avons étudié ce que les patients canadiens ayant récemment été opérés pensent et connaissent des relations financières entre les chirurgiens et les fabricants de matériel chirurgical.

Méthodes : Nous avons mené une étude qualitative portant sur cette question complexe au moyen d’entrevues semi-dirigées effectuées en personne avec des patients qui assistaient, dans un hôpital universitaire de Toronto (Canada), à des rencontres postopératoires à la suite d’une arthroplastie. Les entrevues ont été enregistrées, transcrites, puis analysées, ce qui a mis au jour des notions et des thèmes issus des patients.

Résultats : Nous avons interrogé 33 patients et dégagé 5 grandes conclusions : 1) de nombreux patients ignorent l’existence de relations financières entre les chirurgiens et les fabricants de matériel chirurgical; 2) les patients acceptent les relations financières qui soutiennent l’innovation et la recherche, mais rejettent celles qui ne profitent qu’aux chirurgiens et aux fabricants; 3) les patients ne veulent pas que les relations financières soient divulguées pendant le processus de consentement, car une telle divulgation pourrait détourner l’attention des risques plus importants; 4) les patients sont d’accord pour qu’une surveillance soit exercée par l’ordre professionnel, mais pas par le gouvernement; 5) les patients font confiance aux chirurgiens et croient qu’ils font des choix axés sur leurs patients.

Conclusion : Cette étude qualitative approfondit notre compréhension des relations financières entre les chirurgiens et les autres acteurs du domaine. Les patients soutiennent ce type de relations pourvu qu’elles puissent profiter aux patients actuels et futurs, et croient en notre capacité d’autoréglementation. Ensemble, la divulgation de ces relations et une surveillance appropriée renforceront la confiance du public en la collaboration entre les professionnels et les entreprises.


This paper was presented at the Canadian Bioethics Society Meeting in Montréal, Que., in May 2012, and the Canadian Orthopaedic Association Annual Meeting in Ottawa, Ont., in June 2012.

Accepted for publication Apr. 7, 2015

Acknowledgements: The authors acknowledge Drs. Fiona Webster and Jane McIvor for their assistance in verifying the trustworthiness of our data analysis.

Affiliations: From the Department of Surgery, University of Toronto, (Camp, Gross, McKneally); the Joint Centre for Bioethics, University of Toronto, (McKneally); the Hospital for Sick Children (Camp); and Mount Sinai Hospital, (Gross) Toronto, Ont.

Funding: There was no external funding for this investigation.

Competing interests: None declared.

Contributors: All authors designed the study. M. Camp acquired and analyzed the data, which M. McKneally also analyzed. M. Camp and M. McKneally wrote the article, which all authors reviewed and approved for publication.

DOI: 10.1503/cjs.000815

Correspondence to: M. Camp, Division of Orthopaedic Surgery, The Hospital for Sick Children, 555 University Ave., S107, Toronto, ON., M5G 1X8; mark.camp@sickkids.ca