Journal of General Internal Medicine

, Volume 22, Issue 2, pp 184–190 | Cite as

Physicians and Drug Representatives: Exploring the Dynamics of the Relationship

  • Susan Chimonas
  • Troyen A. Brennan
  • David J. RothmanEmail author
Original Article



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.


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.


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.


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.


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 behavior professionalism social science qualitative research health policy 



This research was supported by the Institute on Medicine as a Profession (IMAP) and the American Board of Internal Medicine (ABIM) Foundation. The authors thank their colleagues on the ABIM–IMAP committee that explored the management of physician conflicts of interest.

Potential Financial Conflicts of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Susan Chimonas
    • 1
  • Troyen A. Brennan
    • 2
  • David J. Rothman
    • 1
    Email author
  1. 1.Center on Medicine as a ProfessionColumbia UniversityNew YorkUSA
  2. 2.Aetna, Inc.HartfordUSA

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