Leana Wen: What Your Doctor Won’t Disclose (Full Transcript)

We don’t just have a fear of sickness, we have a sickness of fear. Can we bridge this disconnect between what patients need and what doctors do? Can we overcome the sickness of fear?

Let me ask you differently: If hiding isn’t the answer, what if we did the opposite? What if doctors were to become totally transparent with their patients?

Last fall, I conducted a research study to find out what it is that people want to know about their healthcare. I didn’t just want to study patients in a hospital, but everyday people.

So my two medical students, Suhavi Tucker and Laura Johns, literally took their research to the streets. They went to banks, coffee shops, senior centers, Chinese restaurants and train stations. What did they find?

Well, when we asked people, “What do you want to know about your healthcare?” people responded with what they want to know about their doctors, because people understand health care to be the individual interaction between them and their doctors.

When we asked, “What do you want to know about your doctors?” people gave three different answers. Some want to know that their doctor is competent and certified to practice medicine.

Some want to be sure that their doctor is unbiased and is making decisions based on evidence and science, not on who pays them.

Surprisingly to us, many people want to know something else about their doctors. Jonathan, a 28-year-old law student, says he wants to find someone who is comfortable with LGBTQ patients and specializes in LGBT health.

Serena, a 32-year-old accountant, says that it’s important to her for her doctor to share her values when it comes to reproductive choice and women’s rights.

Frank, a 59-year-old hardware store owner, doesn’t even like going to the doctor and wants to find someone who believes in prevention first, but who is comfortable with alternative treatments.

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One after another, our respondents told us that that doctor-patient relationship is a deeply intimate one — that to show their doctors their bodies and tell them their deepest secrets, they want to first understand their doctor’s values.

Just because doctors have to see every patient doesn’t mean that patients have to see every doctor. People want to know about their doctors first so that they can make an informed choice.

As a result of this, I formed a campaign, Who’s My Doctor? that calls for total transparency in medicine. Participating doctors voluntarily disclose on a public website not just information about where we went to medical school and what specialty we’re in, but also our conflicts of interest.

We go beyond the Government in the Sunshine Act about drug company affiliations, and we talk about how we’re paid. Incentives matter.

If you go to your doctor because of back pain, you might want to know he’s getting paid $5,000 to perform spine surgery versus $25 to refer you to see a physical therapist, or if he’s getting paid the same thing no matter what he recommends.

Then, we go one step further. We add our values when it comes to women’s health, LGBT health, alternative medicine, preventive health, and end-of-life decisions.

We pledge to our patients that we are here to serve you, so you have a right to know who we are. We believe that transparency can be the cure for fear. I thought some doctors would sign on and others wouldn’t, but I had no idea of the huge backlash that would ensue.

Within one week of starting Who’s My Doctor? Medscape’s public forum and several online doctors’ communities had thousands of posts about this topic.

Here are a few. From a gastroenterologist in Portland: “I devoted 12 years of my life to being a slave. I have loans and mortgages. I depend on lunches from drug companies to serve patients.”

Well, times may be hard for everyone, but try telling your patient making $35,000 a year to serve a family of four that you need the free lunch.

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From an orthopedic surgeon in Charlotte: “I find it an invasion of my privacy to disclose where my income comes from. My patients don’t disclose their incomes to me.”

But your patients’ sources of income don’t affect your health.

From a psychiatrist in New York City: “Pretty soon we will have to disclose whether we prefer cats to dogs, what model of car we drive, and what toilet paper we use.”

Well, how you feel about Toyotas or Cottonelle won’t affect your patients’ health, but your views on a woman’s right to choose and preventive medicine and end-of-life decisions just might.

And my favorite, from a Kansas City cardiologist: “More government-mandated stuff? Dr. Wen needs to move back to her own country.”

Well, two pieces of good news.

First of all, this is meant to be voluntary and not mandatory, and second of all, I’m American and I’m already here.

Within a month, my employers were getting calls asking for me to be fired. I received mail at my undisclosed home address with threats to contact the medical board to sanction me. My friends and family urged me to quit this campaign. After the bomb threat, I was done.

But then I heard from patients. Over social media, a TweetChat, which I’d learned what that was by then, generated 4.3 million impressions, and thousands of people wrote to encourage me to continue.

They wrote with things like, “If doctors are doing something they’re that ashamed of, they shouldn’t be doing it.”

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