Closed Financial Loops: When They Happen in Government, They're Called Corruption; in Medicine, They're Just a Footnote.

Many physicians are involved in relationships that create tension between a physician's duty to work in her patients' best interest at all times and her financial arrangement with a third party, most often a pharmaceutical manufacturer, whose primary goal is maximizing sales or profit. Despite the prevalence of this threat, in the United States and globally, the most common reaction to conflicts of interest in medicine is timid acceptance. There are few calls for conflicts of interest to be banned, and, to our knowledge, no one calls for conflicted practitioners to be reprimanded. Contrast our attitudes in medicine with public attitudes toward financial conflicts among government employees. When enforcement of rules against conflict of interest slackens in the public sector, news organizations investigate and publish their criticism. Yet even when doctors are quoted in the media promoting specific drugs, their personal financial ties to the drug maker are rarely mentioned. Policies for governmental employees are strict, condemnation is strong, and criminal statutes exist (allowing for corruption charges). Yet the evidence that conflict is problematic is, if anything, stronger in medicine than in the public sector. Policies against conflicts of interest in medicine should be at least as strong as those already existing in the public sector.

Lost: Young Canadian physician-scientists need a map.

The termination of dedicated funding for integrated MD-PhD trainees has left biomedical researchers to question the future of physician-scientists in Canada.

Radiology report format preferred by requesting physicians: prospective analysis in a population of physicians at a university hospital / Qual formato de laudo radiológico é preferido pelos médicos solicitantes: análise prospectiva em uma população médica de um hospital universitário

Abstract Objective: To improve communication between attending physicians and radiologists by defining which information should be included in radiology reports and which reporting format is preferred by requesting physicians at a university hospital. Materials and Methods: Respondents were asked to choose among reports with different formats and levels of detail, related to three hypothetical cases, and questioned as to which characteristics commonly found in radiology reports are appropriate for inclusion. To assign the absolute order of preference of the different reports, the Kemeny-Young method was used. Results: Ninety-nine physicians completed the questionnaires (40.4% were resident physicians; 31.3% were preceptors of residency programs; and 28.3% were professors of medicine). For ultrasound with normal findings, ultrasound showing alterations, and computed tomography, respectively, 54%, 59%, and 53% of the respondents chose structured reports with an impression or comment. According to the respondents, the characteristics that should be included in the radiology report are the quality of the image, details of the clinical presentation, diagnostic impression, examination technique, and information about contrast administration, selected by 92%, 91%, 89%, 72%, and 68%, respectively. Other characteristics that were considered important were recommendations on follow-up and additional radiological or non-radiological investigation. Conclusion: Requesting physicians apparently prefer structured reports with a radiologist impression or comment. Information such as the quality of the examination, the contrast agent used, and suggestions regarding follow-up and additional investigation are valued.

Resumo Objetivo: Melhorar a comunicação entre médicos assistentes e radiologistas, definindo quais informações deveriam ser incluídas num relatório radiológico e qual o formato preferido dos solicitantes de um hospital universitário. Materiais e Métodos: Os participantes foram convidados a escolher a opção preferida entre relatórios com diferentes formatos e níveis de detalhamento de três casos hipotéticos e questionados se características comumente encontradas em um laudo radiológico são apropriadas ou não para inclusão. Para atribuição da ordem absoluta de preferência dos diferentes relatórios, o método Kemeny-Young foi utilizado. Resultados: Noventa e nove médicos responderam os questionários (40,4% médicos residentes, 31,3% preceptores dos programas de residência e 28,3% professores da faculdade de medicina). Laudos estruturados com impressão ou comentário foram selecionados nas situações de ultrassonografia normal por 54% dos participantes, ultrassonografia alterada por 59% e tomografia computadorizada por 53%. As informações que deveriam ser incluídas, de acordo com os solicitantes, foram qualidade da imagem (92%), detalhes do cenário clínico (91%), impressão diagnóstica (89%), técnica do exame (72%), informações sobre meio de contraste (68%). Opiniões sobre seguimento e investigação radiológica ou não radiológica se mostraram importantes. Conclusão: Relatórios estruturados com impressão ou comentário de um radiologista são prepostos. Informações como qualidade de exame, meio de contraste utilizado e sugestões de acompanhamento e investigação adicional são valorizadas pelos médicos solicitantes.