Survey seeks views on doctors’ financial ties

University of Auckland researchers are investigating how New Zealand patients feel about, and respond to, ‘self-referrals’ – when doctors refer patients to healthcare providers in which they have a financial stake.

Principal investigator, Professor Jaime King, says the issue of self-referral has been a growing concern in the medical profession as doctors increasingly have investments in the clinics, labs, and specialists to which they refer patients.  

“This creates a conflict of interest,” says King, an expert in health law at Auckland Law School. “Patients trust their doctors to recommend the best care, but financial incentives could be influencing these referrals.”

Although the Medical Council of New Zealand requires doctors to disclose such conflicts of interest, research suggests disclosure alone may not be enough to protect patients.

International studies show that patients often feel uncomfortable questioning their doctor’s recommendation, even when they are advised of, or suspect that a financial motivation may be influencing the medical advice.

“Patients don’t want to seem like they’re implicitly accusing their doctor of bias or unethical conduct,” says co-investigator Professor Jo Manning. “Prior research shows they often go along with the referral anyway, even if it raises concerns for them about trust, bias and whether the medical advice is in their best interests.”

To better understand the experience of New Zealand patients and whether it reflects the international findings, King and Manning have launched a survey to gather patient perspectives on self-referral. They are particularly interested in the views of Māori patients, who may face additional barriers to questioning their healthcare providers.

“This survey seeks to understand people’s experiences of self-referral and to help us consider solutions that could improve trust and transparency and prevent patient harm in the healthcare system,” says Manning.  

One potential solution the researchers are exploring is an enhanced disclosure model, which would include a public registry of doctors’ financial interests, which patients could consult before deciding on a provider. This, they say, could help address the 'insinuation anxiety' that often prevents patients from questioning their doctor’s referrals.  

“Disclosure alone isn’t enough, we need systems that make it easier for patients to understand and act on conflicts of interest,” says King.

Instead of limiting disclosure to consultations, the researchers are interested in a publicly searchable register. This could list each doctor’s conflicts of interest, including its nature, value, and duration, with any new conflicts added as they arise.

This kind of register would allow patients to review information about a practitioner’s conflicts of interest before choosing to enroll with, or consult that practitioner, giving them the time and knowledge to make better-informed decisions.

King and Manning are also interested in the implications of self-referral for competition in the provision of medical services, for patients’ trust in medical practitioners and the medical profession, and for the sustainability of the public health system in New Zealand.