UBC Objectives: Family Medicine

By the end of postgraduate training, using a patient-centred approach and appropriate selectivity, a resident, considering the patient’s cultural and gender contexts, will be able to...

• Differentiate multiple roles a physician may play in the community and the potential for role conflict

The physician, like any other person, may play multiple roles in the community, and whenever anyone assumes any role, this may interact with how they perceive and engage in the world. This can create conflicts of interest. And this is a reality of life. Sometimes physicians can choose not to engage in certain roles because of the negative impact it may have on their ability to provide good care (ex: not taking financial incentives from pharmaceutical companies because it may unduly influence prescribing practices). Other times, the role of the physician is necessarily and unavoidably in conflict (ex: being both a care provider who spends resources to assist patients manage their health issues and also a steward of health care resources who attempts to limit the amount of health care resource expenditure). As I strive to be an ethical family doctor, it is morally imperative for me to reject the assumption of roles that may have a potentially negative impact on my ability to provide best patient care, all things considered, and where possible. When not possible, or when my risk-benefit perception is in favour of adopting a role that may potentially influence my provision of patient care, it is important that I attempt to be as transparent about this as possible, with patients and also with myself, which I believe requires honesty, humility, and curiosity. It requires that I reflect on the roles I assume and how they may influence how I interact with patients and make decisions in their care. It also requires that if I think a role is potentially impairing my ability to provide best care, to work to create a solution, by either abandoning or modifying the role, or worst case scenario, to no longer provide medical care if the care is no longer assuredly safe and sound. Above all else, my identity as a physician must strive to first do no harm. 

The JAMA Network published a simple but informative article titled "Conflict of Interest in Medicine" to help patients understand basic principles of physician conflicts of interest. Of all the Google hits I obtained from searching for articles on physician conflicts of interest, this seemed to be one of the most basic but also the most useful for an overall of understanding this phenomenon as it applies to physician conflicts of interest in general.