The Chicago Tribune reported today that the Federal Government is ready to go live with a searchable database that reports on money drug companies and device-makers have given to physicians and hospitals for research, speaking engagements, and entertainment.
There are dozens of ways to evaluate the quality of your physician, from online rating sites to organizations such as Castle Connolly, with a structured peer nomination and evaluation process, from word of mouth to advice from folks who work inside the system such as nurses.
And, there are dozens of qualities that we care about when choosing and staying with a physician or hospital. Some of those qualities are easier to assess than others. In the past few years, for instance, I’ve been thinking more about my physicians in private practice as business men and women.
For instance, when I was researching the orthopedic surgeon recommended for my daughter’s major spine surgery, I was surprised to see that one of the first hits on Google was for an article he wrote on building and growing business in a private practice.
The doc was a “top doctor,” at Castle Connolly several years ago, and I respect their evaluation. But his savvy, business advice about cutting time with patients before adding physicians to a medical practice plus his aggressive refusal to answer some of my husband’s questions meant that I couldn’t work with him.
From another perspective, when deciding whether or not to stay with my current urologist, I was concerned mostly about how long he’d be in my neighborhood. He’s young and very sharp, and I would guess, going to make a name for himself. This early in his career I’d guess that moving is a possibility.
When I asked him how long he’d be at his current practice, he said, “A long, long time. I’ll make partner in June.”
That’s not a medical commitment or a humanitarian commitment. It’s a business commitment. And, I’ll take it. I hope he will always be my urologist.
So what does this Federal database have to do with doctors’ quality of care and their status as small business men and women? Once I’m able to search data, what should I think if one of my docs takes money from Merck? What should I do about it? Here are four things I’ll do:
First, you can bet that I’ll be first in line to use it. I’ve already found Dollars for Docs on the ProPublica website and searched that database. My hope is that the Federal database will be as easy to use and as reliable.
Second, I’m going to look very carefully at what the money was for. Peter Frost, in the Tribune article, interviews a Harvard Medical School professor who puts it this way:
“To deny that gift-giving does not change behavior is like denying that gravity exists,” said Eric Campbell, a professor of medicine at Harvard Medical School. “It’s absolutely, positively without merit and completely absurd to say it doesn’t.” ……
While Campbell, of Harvard, acknowledges that such relationships are necessary, particularly in research and development, he said the rationale behind some of the payments and gifts has little to do with medicine.
“Taking doctors to restaurants, buying them wine, having them play golf with drug reps — that’s not research,” Campbell said. “I’m not aware of a single medical device that was developed because you took a doctor out for drinks.”
Third, I’m going to talk with my doctors about the database, whether they’ve received gifts or not. It’s important to me to know how my physicians view their role with regard to drug reps, medications they prescribe, and devices that they use.
Fourth, I’m going to pay attention to the health reporting around this issue. Propublica’s “Dollars for Docs” series examines both the federal database and the larger issue of docs and drug companies. They’ve reported, for instance, on kickbacks that docs have received for prescribing certain meds and on the plummeting pay for promotional speaking by the pharmaceutical industry.
And now, I’m going to pause, yet again, to be grateful for the Affordable Care Act. The Sunshine Act was part of the new law and has required that the database be made available.
For more information, see Peter Frost’s article and video at the Chicago Tribune here.
Propublica’s Dollars for Docs has extensive data and reporting here.
The Federal Database is here:
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