Quality/Medical Errors

Physicians should disclose financial incentives, address patients' reactions, and negotiate a fair plan to win trust

Many U.S. physicians receive financial incentives to limit their ordering of expensive tests and procedures, and most consumers want to know how these incentives affect their care. A new study reveals that some disclosure strategies are more likely to invoke patient trust, a clearer understanding of physician motivation, and a greater willingness to remain with the physician and health plan. The study was supported by the Agency for Healthcare Research and Quality (HS09982).

Ideally, the physician should disclose financial incentives to limit testing, address patients' reactions, and negotiate a fair plan to win their trust. This is particularly important among minority patients who are less quick to trust health care professionals in general, explains Wendy Levinson, M.D., of the University of Toronto.

Dr. Levinson and her colleagues analyzed responses from the 2002 General Social Survey of 2,765 English-speaking U.S. households. Those interviewed discussed their reaction to an audiotaped scenario of a physician discussing the impact of financial incentives on ordering a magnetic resonance imaging (MRI) exam. The subjects heard one of six randomly selected disclosure strategies. Nearly all respondents (95 percent) wanted to be told about incentives, and 80.5 percent wanted to be told at the time of enrollment in a health plan.

Patients were least likely to seek a second opinion about the necessity of an MRI with two strategies: "addressing emotions" (encouraging patients to share concerns, even if conflict surfaces) and "negotiation" (examining physician and patient perspectives and finding an acceptable plan for both). They perceived referring to a "common enemy" (that is, the health plan policies) and "denying influences" (of health plan incentives) most negatively.

See "The effect of physician disclosure of financial incentives on trust," by Dr. Levinson, Audiey Kao, M.D., Ph.D., Alma M. Kuby, M.B.A., and Ronald A. Thisted, Ph.D., in the March 28, 2005, Archives of Internal Medicine 165, pp. 625-630.

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