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September 9, 2013

An Organizational Approach to Conflicts of InterestLessons From Non–Health Care Businesses

Author Affiliations
  • 1Scott and White Healthcare, Temple, Texas
  • 2Health Sciences Center, College of Medicine, Texas A & M University, Temple

Copyright 2013 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Intern Med. 2013;173(16):1489-1490. doi:10.1001/jamainternmed.2013.8897

The best interests of patients, the public, and the medical profession should guide people engaged in health care, medical research, and education. Conflicts of interests arise when professionals and organizations act in ways that do not further the best interests of the intended beneficiaries of their services.

The medical profession has historically assigned accountability for avoiding and managing conflicts of interest to individual physicians.1 Increasingly, however, health care organizations employ physicians.2 Physician employees may have their primary responsibility to patient welfare “divided” by the competing interests of their employers.2 One solution might be to have the primary responsibility for conflicts of interest remain with the physician employee, with the employer supporting the physician in managing them.1 Yet physician responses to various tenets of professionalism, including those directly related to conflicts of interest, have been quite malleable, even when they acknowledged and strongly agreed with principles designed to guide more standard and predictable responses.3 Alternatively, health care organizations might assume responsibility for conflicts of interest. This latter approach could be problematic because health care organizations might prioritize organizational interests like financial gain2 over patient welfare. Most health care organizations have conflict of interest policies. There are, however, few data showing how the mere fact of having such policies influences the actions of physician employees with regard to conflicts of interest.

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