How to Fight Fear and Restore Trust in Medicine

For the last week, I’ve been trying something new. This is how I've been introducing myself to my patients in the ER:
"I'm Dr. Leana Wen. I'm your doctor. I belong to an initiative called "Who's My Doctor," that aims for transparency in medicine. I accept no money from drug companies or device companies. I do not make any more from ordering more tests or procedures on you, and I also don't make more for ordering less. I'm telling you this so that you can be sure that everything I do for you is in your best interest."
When you go to the doctor, we ask you to be open with us. You tell us your story. You show us your body. You allow us to know everything about you.
But how much do you know about your doctor?
In the old days, when you had one doctor for many years, you might have known a lot. However, today's medical landscape is very different. Few patients have longstanding relationships with their doctors. They have little to go on when deciding who to trust with their health, then they are kept in the dark on matters ranging from cost of care to doctors' motivations to necessity of tests and treatments.
When
my mother was diagnosed with breast cancer, it took her months to find an oncologist she liked. One day, while trying to locate his office number online, she found a listing for him as a highly paid consultant and speaker for a drug -- the same chemotherapy drug that he'd put her on. This might have still been the right treatment for her, but it made her wonder and it made her scared.
Studies show that as many as
94 percent of doctors report an affiliation with and receive money from drug companies and medical device companies. Though doctors deny these payments influence their decision-making, ample research demonstrate that it does.
Many doctors'
salaries also depend on number of procedures done. Your doctor recommends a hip replacement surgery -- is it because it's really the best option, or because she has a financial incentive to do the procedure? At a time when 30 percent of all tests and treatments are unnecessary, patients have a right to know what may be influencing their doctors' recommendation about their health.
If your doctor has an uncommon name, you might be able to play Google detective and uncover that they receive significant income from a drug company (see ProPublica investigation, "
Dollars for Docs"). You may also find their Facebook profile or a doctor rating site. But that's not very much information to go on to figure out who your doctor really is.
The "
Who's My Doctor?" project is a new campaign where doctors produce a voluntary, public disclosure statement, "The Total Transparency Manifesto" (see mine here). We disclose every financial connection to pharmaceutical and medical device companies. We write what contribution of our salary is from doing tests and procedures. We tell you our personal and professional details and describe our philosophy of practice. We explain who we are, as doctors and as people.
I started "Who's My Doctor?" because I know that patients come to me in a time of great fear and vulnerability. If I have something to hide -- or if my patients suspect I have something to hide -- then that only leads to defensiveness and more fear. The antidote to fear is honesty and transparency, and I want to let my patients know who I am.
With my disclosure, I am holding myself publicly accountable to my patients. I am saying that I don't have anything to hide from you. I know you are vulnerable, but I'll be vulnerable with you. This is a partnership. We're in this together.
Some patients may well decide that this information is irrelevant and never seek it out. However, it should be available in a public, easily searchable database for those who do think it matters. Patients then have the option of identifying a doctor whose philosophies match their own. They can also help to encourage their doctor to participate in this project.
Some doctors may have qualms about their information being available on such a public forum. However, in the era of Google and social media, much of this information can already be found online, and having a voluntary disclosure gives more control to the doctor. Also, experience with other transparency pilots such as
open medical records has demonstrated that openness leads to better communication, improved trust and better care. I've had the great privilege of working with and learning from so many wonderful health professionals over the years. There are so many people who went into medicine for the right reasons who are struggling against a broken health care system. "Who's My Doctor?" is our effort to join together and call for a new professionalism. It is our hope that our patients will join us in building a better health care system, one that prioritizes patient values and respects human dignity.
If you are a health care provider and would like to participate in "Who's My Doctor?," please contact me. If you are a patient, I would love to know what you think, too. Over the next few months, I'll be blogging about my own experiences as well as the experiences of my fellow transparent doctors and our patients. Please join us in this new mission to counter fear and restore trust.

This blog was published in
Huffington Post on Oct 17th 2013.