Managing surgical conflicts of interest
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* Jasmine Z. Cheng

I read with interest the article on the potential conflicts of interest in surgeons’ selective use of company manufactured medical devices.1 The article quotes a 2014 paper in *BMC Medical Ethics,* where Johnson advocates for action to mitigate surgeon bias on a larger scale that cannot be accomplished by disclosure alone.2

The desire to foster cultural change through education and institutional policy are optimistic goals to aspire to, but these goals require tremendous time, effort and physician motivation and compliance. To get to the big changes in medical culture, it is important to see disclosure in a positive light, rather than in a limited, negative one, and be reminded of its benefit to all parties involved. In a recent paper, Sah and colleagues investigated the effect of physician disclosure of potential bias on patient trust and treatment choice.3 In this randomized control study, they found that physicians (including surgical specialists) who adopt an honest and deliberate approach in informing patients of potential bias and incentivized conflict of interest, and who encourage seeking alternate consultations and second opinions, in fact, build patient trust and compliance with their recommendation.

Rome wasn’t built in a day, but they were laying bricks every hour. The cornerstone of managing surgical conflict of interest may be a shift in perspective of the cost–benefit of disclosure.

## References

1.  Collier R. Managing surgical conflicts of interest. CMAJ 2016;188:1069.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTg4LzE1LzEwNjkiO3M6NDoiYXRvbSI7czoyMDoiL2NtYWovMTg5LzEvRTMyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

2.  Johnson J, Rogers W. Joint issues — conflicts of interest, the ASR hip and suggestions for managing surgical conflicts of interest. BMC Med Ethics 2014;15:63.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1186/1472-6939-15-63&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=25128372&link_type=MED&atom=%2Fcmaj%2F189%2F1%2FE32.atom) 

3.  Sah S, Fagerlin A, Ubel P. Effect of physician disclosure of specialty bias on patient trust and treatment choice. Proc Natl Acad Sci U S A 2016;113:7465–9.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoicG5hcyI7czo1OiJyZXNpZCI7czoxMToiMTEzLzI3Lzc0NjUiO3M6NDoiYXRvbSI7czoyMDoiL2NtYWovMTg5LzEvRTMyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==)