Registrar's message: Medicine and morals—managing conflict of interest in practice and in regulation

An important duty of every physician is to provide care that is in the best interest of their patients. However, in addition to caring for patients, many physicians also participate in other activities, such as teaching medical students, supervising recent graduates, conducting research studies, or helping to develop new drugs or medical devices. Through these activities, physicians often form relationships with people, businesses and organizations, thereby creating opportunities for conflicting interests to arise.

To address these possible conflicting interests and provide physicians with a robust set of principles, the College has published a revised Conflict of Interest practice standard. This standard underwent a consultation with the profession and the public in January 2019. The majority of registrants who responded felt the revised standard was appropriate, however, further clarity on specific principles was requested.

The public feedback showed that patients value honesty, and that disclosure by their physician about any physician-industry relationship is imperative in maintaining a trusting relationship. In accordance with the consultation themes, the standard was revised to be more explicit, and to focus on appropriate communication and disclosure to the patient. The revised standard has adopted principles from the College's existing Conflict of Interest Arising from Clinical Research professional guideline, which has now been archived, and addresses conflict of interest in relationship to industry and educational activities.

Just as physicians must provide care in the best interest of their patients, the College must regulate physicians in the best interest of the public. In serving the public, the College participates in a variety of activities to engage and inform registrants, such as holding an annual Education Day, speaking at conferences for physicians, and holding consultations. Through these activities, opportunities are created for a conflict of interest to arise if what is best for physicians diverges from what is best for the public.

To address these conflicting interests, the College must maintain clarity that its statutory duty is to serve and protect the public interest. The College must constantly evaluate any possible influence that a physician or a physician group may have on its duty as a regulator and use appropriate language in communications to underscore the College’s primary mission and mandate.

How the College refers to physicians who are registered with the College is a good example of the importance of language and its intended meaning.

As highlighted in the recently published report, An Inquiry into the performance of the College of Dental Surgeons of British Columbia and the Health Professions Act, by Mr. Harry Cayton, past executive director of the Professional Standards Authority in the UK, health professionals who are licensed and registered with a BC health regulator are referred to as registrants of a College; they are not members as they might be of a voluntary association or society, which allows them some opportunity to advance a particular interest of the membership.

While College registrants are invited to provide feedback on some College matters, such as the development of standards, they do not get to vote on a direction or course of action, and they are not represented at the boardroom table. Governors of regulatory authorities don’t have constituents, and having a seat at the regulatory table is not about representation.

By appropriately managing any real or perceived conflicts of interest, through the development of comprehensive practice standards and continued reflection and disclosure of contradictory relationships, both registrants and the College can work together to protect the patients and the public they are entrusted to serve.

Heidi M. Oetter, MD
Registrar and CEO

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