title: "We can't get along without each other": Qualitative interviews with physicians about device industry representatives, conflict of interest and patient safety.
abstract: OBJECTIVE
  Physician relationships with device industry representatives have not been previously assessed. This study explored interactions with device industry representatives among physicians who use implantable cardiovascular and orthopedic devices to identify whether conflict of interest (COI) is a concern and how it is managed.
  
  
  METHODS
  A descriptive qualitative approach was used. Physicians who implant orthopedic and cardiovascular devices were identified in publicly available directories and web sites, and interviewed about their relationships with device industry representatives. Sampling was concurrent with data collection and analysis. Data were analyzed and discussed using constant comparative technique by all members of the research team.
  
  
  RESULTS
  Twenty-two physicians (10 cardiovascular, 12 orthopedic) were interviewed. Ten distinct representative roles were identified: purchasing, training, trouble-shooting, supplying devices, assisting with device assembly and insertion, supporting operating room staff, mitigating liability, conveying information about recalls, and providing direct and indirect financial support. Participants recognized the potential for COI but representatives were present for the majority of implantations. Participants revealed a tension between physicians and representatives that was characterized as "symbiotic", but required physicians to be vigilant about COI and patient safety, particularly because representatives varied regarding disclosure of device defects. They described a concurrent tension between hospitals, whose policies and business practices were focused on cost-control, and physicians who were required to comply with those policies and use particular devices despite concerns about their safety and effectiveness.
  
  
  CONCLUSIONS
  Given the potential for COI and threats to patient safety, further research is needed to establish the clinical implications of the role of, and relationship with device industry representatives; and whether and how hospitals do and should govern interaction with representatives, or support their staff in this regard.
authors.affiliation: Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Anna R
authors.identifier: http://orcid.org/0000-0002-5721-809X
authors.initials: AR
authors.lastname: Gagliardi
authors.affiliation: Department of Public Health Administration, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Pascale
authors.initials: P
authors.lastname: Lehoux
authors.affiliation: Department of Sociology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Ariel
authors.initials: A
authors.lastname: Ducey
authors.affiliation: Institute of Biomaterial & Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Easty
authors.affiliation: Women & Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sue
authors.initials: S
authors.lastname: Ross
authors.affiliation: Department of General Internal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Chaim
authors.initials: C
authors.lastname: Bell
authors.affiliation: Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Trbovich
authors.affiliation: Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: David R
authors.initials: DR
authors.lastname: Urbach
mesh_terms: D016265:Conflict of Interest; D006801:Humans; D061214:Patient Safety; D010820:Physicians