Competing and conflicting interests in the care of critically ill patients

Alison E Turnbull; Sarina K Sahetya; E Lee Daugherty Biddison; Christiane S Hartog; Gordon D Rubenfeld; Dominique D Benoit; Bertrand Guidet; Rik T Gerritsen; Mark R Tonelli; J Randall Curtis

doi:10.1007/s00134-018-5326-2

Competing and conflicting interests in the care of critically ill patients

Intensive Care Med. 2018 Oct;44(10):1628-1637. doi: 10.1007/s00134-018-5326-2. Epub 2018 Jul 25.

Authors

Alison E Turnbull^{1

2

3}, Sarina K Sahetya⁴, E Lee Daugherty Biddison⁴, Christiane S Hartog^{5

6

7}, Gordon D Rubenfeld^{8

9}, Dominique D Benoit¹⁰, Bertrand Guidet^{11

12

13}, Rik T Gerritsen¹⁴, Mark R Tonelli^{15

16}, J Randall Curtis^{16

17}

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, 1830 E. Monument St, 5th Floor, Baltimore, MD, 21205, USA. turnbull@jhmi.edu.
² Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. turnbull@jhmi.edu.
³ Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA. turnbull@jhmi.edu.
⁴ Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, 1830 E. Monument St, 5th Floor, Baltimore, MD, 21205, USA.
⁵ Department for Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany.
⁶ Department of Anaesthesiology and Operative Intensive Care Medicine, Charité Universitätsmedizin Berlin, Kreischa, Germany.
⁷ Patient- and Family-Centered Care, Klinik Bavaria, Kreischa, Germany.
⁸ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
⁹ Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹⁰ Intensive Care Unit, Ghent University Hospital, Ghent, Belgium.
¹¹ Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France.
¹² Sorbonne Universités, Université Pierre et Marie Curie, Paris, France.
¹³ Institut National de la Santé et de la Recherche Médicale (INSERM), UMR S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France.
¹⁴ Department of Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands.
¹⁵ Department of Bioethics and Humanities, University of Washington, Seattle, WA, USA.
¹⁶ Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA.
¹⁷ Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA.

Abstract

Medical professionals are expected to prioritize patient interests, and most patients trust physicians to act in their best interest. However, a single patient is never a physician's sole concern. The competing interests of other patients, clinicians, family members, hospital administrators, regulators, insurers, and trainees are omnipresent. While prioritizing patient interests is always a struggle, it is especially challenging and important in the ICU setting where most patients lack the ability to advocate for themselves or seek alternative sources of care. This review explores factors that increase the risk, or the perception, that an ICU physician will reason, recommend, or act in a way that is not in their patient's best interest and discusses steps that could help minimize the impact of these factors on patient care.

Keywords: Clinical studies as topic; Conflict of interest; Critical care; Patient-centered care; Research design.

Publication types

Review

MeSH terms

Conflict of Interest*
Critical Illness*
Humans
Physician-Patient Relations
Physicians
Trust

Grants and funding

L30 HL129364/HL/NHLBI NIH HHS/United States