Patient-provider discussions about conflicts of interest in managed care: physicians' perceptions.

BACKGROUND: Patients worry about financial conflicts of interest related to cost containment but may hesitate to share this concern with their physician. Little is known about how this issue affects encounters between doctors and patients, or about the communication strategies physicians endorse for responding to such concerns.

OBJECTIVE: To understand physicians' perspectives on how managed care patients' concerns about conflicts of interest are impacting the physician-patient relationship in routine visits.

STUDY DESIGN: Qualitative analysis of physician focus groups. Physicians also rated audiotaped dialogues of different communication strategies for discussing conflicts of interest with patients.

PARTICIPANTS: Thirty-nine community physicians (25 general internists and 14 family practice physicians) in Portland, Oregon--a highly penetrated managed care market. Physicians' average age was 44 years; 36% were women.

RESULTS: These physicians report that patient concern about financial conflicts of interest is implicit in many patient encounters. However, patients rarely ask directly about conflicts of interest. Physicians believe that patients' concerns about conflicts of interest are impairing doctor-patient relationships and damaging physicians' sense of professional worth. Physicians prefer communication strategies for discussing conflicts of interest that address patients' emotions or identify a common goal through negotiation. These physicians seldom initiate discussions with patients about conflicts of interest.

CONCLUSIONS: Patient concern about conflicts of interest is adversely impacting the physician-patient interaction. Physicians should be alert to patients' implicit expressions of concern about conflicts of interest, and practice communication techniques for responding to these concerns effectively.