TEDMED speaker: Physician transparency a potential curative for patient fear

It’s time for physicians to be more transparent with their patients, according to Leana Wen, MD, director of patient-centered research at George Washington University, Rhodes scholar and co-author of When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.

Wen’s mother went online to look up her oncologist’s telephone number after she developed breast cancer. She discovered her physician was highly paid by the manufacturers of the same chemotherapy regimen she was prescribed to treat the cancer, and that the physician often spoke about the regimen.

“I didn’t know what to believe,” Wen told the audience at TEDMED 2014 in San Francisco. “Maybe this was the right chemo regimen for her, but maybe it wasn’t. It made her scared and gave her doubt. Having trust is a must, and when that trust is gone, all that is left is fear.”

Wen saw another side of fear when she suggested the parents of a trauma patient be present when the group made its rounds. The head physician was resistant, and said the patient’s parents might get in the way of the nurses, or prevent students from asking questions.

Hiding behind white coats

“What I saw behind every excuse was deep fear,” Wen said. “What I learned was that when we become doctors, we have to put on our white coats, put up a wall and hide behind it. It’s not just patients who are scared. Doctors are scared, too. We’re afraid of patients finding out who we are and what medicine is all about.”

Hiding behind the white coat is a problem, she added. “The more we hide, the more people want to know what we’re hiding, and more fear then spirals into mistrust.”

These revelations were some of the events that prompted Wen to conduct a survey to learn what people want to know about their health care. Her medical students went to banks, coffee shops, senior centers, train stations and other places, and asked people what they wanted in their health care. She said that many people wanted to know about their doctors, and they responded in three ways: “Some wanted to know if their doctor is competent and certified. Some wanted to know that their doctor is unbiased and making decisions based on evidence and science, not on who is paying them,” Wen said. “Surprisingly to us, many people wanted to know something else about their doctors.”

Exposing physician values

Knowing about a physician’s value system is important to some patients, Wen learned. One respondent said she wanted to know if her physician shared her values on reproductive choice, while another said finding a physician comfortable with LGBTQ issues was important to her. Another wanted a physician who believes in prevention first and is comfortable with alternative treatments.

“One after another, our respondents told us that the doctor-patient relationship is a very intimate one, that to show their doctors their bodies and share their deepest secrets, they want to first understand their doctor’s values.”

As a result, Wen started a campaign she called “Who is my doctor?” It is a website where doctors voluntarily share information about themselves beyond where they went to medical school, and also beyond the provisions in the Sunshine Act calling for information on how physicians are paid, not only by drug companies, but for procedures. It also includes details about the physicians’ values, such as their feelings about reproductive health, alternative medicine and end-of-life decisions.

“We pledge to our patients that we are here to serve you, so you have a right to know who we are,” she said. “We believe that transparency can be the cure for fear.”

Stirring up emotions

Wen said she had no idea her campaign would quickly cause an enormous backlash.

Thousands of posts had been made about the topic on physicians’ websites within the first week. According to Wen, an orthopedic surgeon in Charlotte wrote, “I find it an invasion of my privacy to disclose where my income comes from. My patients don’t disclose their incomes to me.”

Wen responded by saying the physician’s health is not affected by the patient’s income sources.

“They told me I was a traitor to my own profession. They told me I should be fired. They told me I should have my medical license taken away. They told me I should go back to my own country. My email got hacked,” Wen told the audience. She said that within a month, her employers were getting calls to terminate her, and she received mail at her home address threatening to contact the medical board to sanction her.

“I never thought I would do something that would provoke so much anger from other doctors.”

Friends and family urged her to give up the campaign.

“After the bomb threat, I was done,” Wen said. “But then I started to hear from patients.”

A chat on Twitter generated 4.3 million impressions, according to Wen. Some patients said that elected officials and lawyers have to disclose funding sources and conflicts of interest; therefore, physicians should too. Wen said that another wrote, “If doctors are doing something they are that ashamed of, they shouldn’t be doing it.”

Physicians who have signed onto her transparency initiative have reported improved relationships with their patients, Wen said.

According to Wen, one physician wrote: “This has brought me closer to my patients. The type of relationships I developed — that’s why I went to medical school.”

Another said: “My colleagues ask me how I can be so brave. It’s not being brave. It’s my job.”

For more information:

Wen L. Presented at: TEDMED 2014; Sept. 10-12, San Francisco.