Journal of General Internal Medicine

, Volume 22, Issue 2, pp 184–190

Physicians and Drug Representatives: Exploring the Dynamics of the Relationship

Authors

  • Susan Chimonas
    • Center on Medicine as a ProfessionColumbia University
  • Troyen A. Brennan
    • Aetna, Inc.
    • Center on Medicine as a ProfessionColumbia University
Original Article

DOI: 10.1007/s11606-006-0041-z

Cite this article as:
Chimonas, S., Brennan, T.A. & Rothman, D.J. J GEN INTERN MED (2007) 22: 184. doi:10.1007/s11606-006-0041-z

Abstract

Background

Interactions between physicians and drug representatives are common, even though research shows that physicians understand the conflict of interest between marketing and patient care. Little is known about how physicians resolve this contradiction.

Objective

To determine physicians’ techniques for managing cognitive inconsistencies within their relationships with drug representatives.

Design, Setting, and Participants

Six focus groups were conducted with 32 academic and community physicians in San Diego, Atlanta, and Chicago.

Measurements

Qualitative analysis of focus group transcripts to determine physicians’ attitudes towards conflict of interest and detailing, their beliefs about the quality of information conveyed and the impact on prescribing, and their resolution of the conflict between detailers’ desire to sell product and patient care.

Results

Physicians understood the concept of conflict of interest and applied it to relationships with detailers. However, they maintained favorable views of physician–detailer exchanges. Holding these mutually contradictory attitudes, physicians were in a position of cognitive dissonance. To resolve the dissonance, they used a variety of denials and rationalizations: They avoided thinking about the conflict of interest, they disagreed that industry relationships affected physician behavior, they denied responsibility for the problem, they enumerated techniques for remaining impartial, and they reasoned that meetings with detailers were educational and benefited patients.

Conclusions

Although physicians understood the concept of conflict of interest, relationships with detailers set up psychological dynamics that influenced their reasoning. Our findings suggest that voluntary guidelines, like those proposed by most major medical societies, are inadequate. It may be that only the prohibition of physician–detailer interactions will be effective.

Key words

physician behaviorprofessionalismsocial sciencequalitative researchhealth policy

Copyright information

© Society of General Internal Medicine 2007