Appendix B
Physician Discussion Guide
Welcome and Introductions (5 minutes)
 Welcome, thanks for coming
 Explanation of ground rules: independent moderator, one-way mirror,
videotaping, open honest answers
 Introductions: physicians introduce themselves to the group. First name,
what they practice, and where they practice
Conflicts of Interest – Awareness and Perceptions (20 minutes)
 What comes to mind when you hear the phrase “conflict of interest?”
 Please share all thoughts that come to mind.
 (Moderator writes down all responses on a large white pad of paper.)
 Is this a familiar phrase? Have you heard it before? If so, in what context?
 Can you define conflict of interest for me?
 Is this an issue that concerns you?
 Is this something you talk about with your colleagues?
 Is there an opportunity to teach about this to residents?
 How aware do you think patients are regarding conflicts of interest?
 Why do you think that?
 Have you ever heard of the Pharma Code? If so, can you please explain your
understanding?
 What is your sense of the harm of conflicts of interest?
 Are there different kinds of harms?
 Are there differing degrees of harms? Please explain.
 Do you feel that you have ever been involved in a position of conflict of
interest?
 Would anyone like to share their experiences?
 Have you ever disclosed a conflict of interest to a patient? Why/why not?
Types of Conflicts of Interest – Individual Discussion (20 minutes)
 Now, I am going to share some examples of conflicts of interest with you all.
The following conflicts will be discussed:
 Relationship between pharmaceutical representatives and doctors
 Ex: expensive dinners for docs paid for by pharmaceutical reps so docs
will prescribe certain medication
 Payments for getting patients to participate in clinical trials
 Ex: A patient has high cholesterol and the physician recommends that the
patient enroll in a clinical trial for a new drug that could help lower their
cholesterol. If they enroll in the trial, the doctor will receive $3,000 from
the drug company.
 CME
 Ex: Physicians are required to take courses each year to maintain their
knowledge and skill. Funding for these courses often comes from drug
companies. So, a physician may be hired by a drug company to give a
speech about a certain condition that their drug treats. The physician gets
paid from the drug company.
 Practice Guidelines
 Ex: Physicians who are involved in setting the practice guidelines may
have financial ties to the drug companies. Thus, certain drugs may
appear in the treatment guidelines.
 Ex: Physicians serve as paid consultants for the drug companies or
receive grants from the companies to support medical research.
Questions for Each Type of Conflict
 Are you aware of these types of conflicts?
 How do you feel about them?
 Have you ever experienced any of these?
 Do you feel that these are acceptable?
 How aware do you think patients are about these types of conflict of interest?
 How do you think patients feel about these conflicts?
 Have you ever experienced any of these conflicts?
Size of Conflict
 Is there a distinction in your minds about the type of conflicts of interest and
how acceptable they are/are not? Are there some conflicts that are ok in
your minds?
 Is there a distinction between modest/lavish gifts?
Injury vs. False Information
 As we have discussed, conflicts can cause problems in two areas: they can
cause injury to the patient and/or they can create the potential for false
information. In your opinion, are they equally important? Do you find one
more troublesome than the other? Why? Explain.
Type of Funding
 Does the type of funding affect your opinion of the conflict?
 For example, does it matter to you where the money comes from (ex:
insurance company, drug industry, durable medical equipment manufacturer
etc.)
Quick Comparison
 Are there certain conflicts that we have discussed that affect you more than
others? Do specific conflicts stand out to you for one reason or another?
Which ones and why?
 Are there conflicts that you have experienced/heard of that we have not
mentioned?
Disclosure (10 minutes)
 In your opinion, what would be the best way to handle conflicts of interest?
 What is an acceptable and realistic remedy?
 Would you be comfortable disclosing your conflict of interest with patients?
 How do you think patients would like these situations to be handled?
Control of Conflicts (5 minutes)
 How do you think conflicts of interest are being managed?
 Who would be in charge of this type of management?
 Do you feel like there is any professional oversight governing conflicts?
 Is structural oversight of conflicts necessary? Why/why not?
 Do you feel that oversight can be controlled by doctors and medical societies
or do you feel that the government should step in? Why?
Moderator goes into back room for additional questions.
Final comments
Thanks and goodbye