Conflict of Interest:
Disclosure Alone isn’t the End…

Navigating the delicate ethics of industry relationships in medicine

In an era where accountability within medicine has never been more important, we ask: Should patients be able to open their laptop and easily find out who is paying their doctor—and whether those payments could influence medical decisions?

No one is immune to conflicts of interest. Doctors, like everyone else, are vulnerable to bias—particularly when money, prestige, or professional advancement is involved. These biases are rarely conscious or malicious. But they are real, and evidence shows they influence behaviour.

Professor Pauline Allen put it plainly: “Making a declaration about your conflict of interest doesn’t make it go away. You still have a conflict—the only difference now is that everyone knows about it.”

Disclosure alone doesn’t neutralise influence. If fact, sometimes it can have the opposite effect - providing a false sense of moral immunity.

The King of Medical Representatives

Take Stryker, for example. And apologies to them—but they’ve practically become the final boss of all medical reps. You’ll often find them just outside the nearest orthopaedic theatre, ready to introduce their latest hardware. They’re knowledgeable, personable, and undeniably helpful.

But that's exactly the problem.

In a compelling talk on conflict of interest, Surgeon Chris de Gara describes how representatives like these have moved beyond simple product promotion. Today, they embed themselves into the daily fabric of clinical practice—present in training sessions, education conferences, and even journal clubs. They offer mentorship, sponsor events, and in doing so, shape the professional environment itself.

This isn’t crude bribery. It’s relationship-building.

The Psychology of Influence

If you think you're immune, consider the work of behavioural economist Dan Ariely, who explored this in Predictably Irrational. He showed that even small gifts trigger disproportionate feelings of goodwill. That’s not a fault in our character—it’s a feature of human cognition. We’re wired to reciprocate, even when we’re not conscious of it.

Take one simple statistic: Grand round attendance increases by 38% when free food is provided. This isn’t because the content improves. It’s because gifts, even trivial ones, change behaviour.

If a sandwich can shape turnout, what can sponsorship, consultant fees, or device royalties do to prescribing, referrals, or product preferences? Look at the millions Pfizer pays doctors to do research, public speaking or consulting.

A Bit of Nuance

Let’s be clear - Conflict of Interest does not equal bias. Donald Miller argued this perfectly:

“A conflict of interest does not equal bias—but conflicts may prompt bias. Having a conflict of interest is neither immoral nor unethical. What is unethical is to act on a conflict in such a way that cannot be justified morally.”

Conflicts of interest are sometimes unavoidable in professions like medicine and if doctors are able to participate in research, advise pharmaceutical or device companies, to improve patient outcomes and drive innovation then many would count that as a success… but there’s a difference between having a conflict of interest and being compromised by it.

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Teenagers Prefer the NHS Over NASA…

For the second year running, “Doctor” has topped the list of careers teenagers most want, according to BBC Bitesize’s annual careers survey. And when asked where they’d work if they could choose anywhere in the world? The NHS came first—beating Google, Apple, and even NASA.

How interesting - It seems the noise surrounding the UK medical profession hasn’t put the next generation off, if anything, they’re even more inspired. Many will point to naivety but teenagers aren’t completely blind to the strikes or repeated talk of NHS strain on the news—but they still choose medicine. A study from Deloitte show Gen Z values meaningful, socially impactful work over high salaries or flashy perks.

Despite the disillusionment voiced within the profession, its core values still clearly resonate deeply: helping people, solving problems, making tangible impact…

Hands of Steel, Mouths of Sailors: Who Has the Steadiest Hands in Healthcare?

What a children’s game revealed about dexterity and swearing as a secret weapon

Whenever the topic of dexterity under pressure comes up in a hospital tea room, you’ll reliably find a surgeon (possibly mid-biscuit) claiming they have the steadiest hands in the NHS. But is this just another example of ‘the Surgeon’s ego’ or is there some truth to be found?

Tobin Joseph and colleagues from Leeds Teaching Hospitals NHS Trust decided to test the myth in the most scientific way possible: not with a scalpel or suturing challenge, but with a children’s buzz wire game.

A total of 254 hospital staff—including 64 surgeons—were roped into the dexterity NHS gameshow. The challenge was to successfully complete the buzz wire game within five minutes. The secondary, and far more entertaining, outcome: how often they swore or made audible noises of frustration.

Surgeon’s Dominate, But at What Cost?

Turns out, the surgeons weren’t lying: 84% completed the game successfully within the time limit, significantly outperforming physicians (57%), nurses (54%), and non-clinical staff (51%). They also did it faster (even independent of age and gender).

But it doesn’t end there - What surgeons gained in dexterity, they lost in mouth control. They swore more than any other group. Interestingly however, they didn’t top the charts in audible noises of frustration… non-clinical staff led the pack in frustrated groaning and sighing. So it seems that a surgeon’s way of expressing frustration involves the expletives.

There’s increasing evidence that swearing has performance-enhancing effects, particularly under physical or emotional stress. A 2009 Keele University study showed that swearing increased pain tolerance. Could it be that surgeons—consciously or not—are tapping into a primal system of self-regulation in a Novak Djokovic racket-smashing fashion? (GMC look away now).

Not everyone will be clapping for On-Call’s celebration of surgical swearing. Some may point to the well-documented psychological phenomenon of emotional contagion, where one team member’s vocal stress responses can subtly influence the entire room—potentially affecting the focus and confidence of the anaesthetist, resident doctor, or scrub nurse.

And then there’s professionalism. While medicine is evolving beyond rigid formality, how we’re perceived still matters. Insights from workplace psychology consistently show that swearing in professional settings is often interpreted as aggressive or lacking composure. In a field where trust, authority, and calm leadership are paramount, no one wants their competence questioned before a scalpel is even lifted or an instruction is given.

What Now?

So, should we be adding buzz wire challenges to medical school admissions and surgical interviews? Maybe even installing them in theatres as part of the pre-op warm-up routine? And what does all this mean for our attitudes toward swearing in clinical settings?

As ever, On-Call might have created more questions than it’s settled…

“First referral of the day: ?Appendicitis, PMH: Right Hemicolectomy - we used to be a serious profession”

“If you're nearing the end of training and torn between the DGH or tertiary centre life, focus less on the hospital and more on the team you'll be working with. Do your homework—find where you'll fit best. A good rule of thumb: do you have a hyperspecialised interest, or do you prefer the variety that comes with DGH work”

“Slightly biased with my pre-radiology experience but I have found GI radiologists to be held in very high regard by their gastroenterology and surgical colleagues. General surgery consultants will often make radiology their first stop prior to ward rounds to discuss difficult cases and they rely heavily on the radiologists to inform their decision making.”

“Nurse here and I love it when the ward doctors share our staff room and don’t isolate themselves in the mess”

What’s on your mind? Email us!

Some things to review when you’re off the ward…

A leaked report reveals that political rhetoric surrounding immigration is dissuading top global cancer doctors and researchers from relocating to or remaining in the UK. (The Guardian)

NHS Considers 'Standby Patient System' to Reduce Surgical Cancellations: A report by health tech firm Proximie suggests the NHS implement a "standby patient system" to address approximately 135,000 annual same-day surgical cancellations in the UK due to patient absence or illness, costing around £400 million. (The Sunday Times)

Fluid restriction and heart failure… Once a perfect match, but nowadays the centre of many clinical questions. A recent multicentre trial published in Nature randomised 504 people with chronic heart failure to receive advice for liberal fluid intake or 1.5L per day restriction and found no difference in health status or safety events between the two groups…

Hear the words of Dr. Partha Kar on the future of the Royal College of Physicians. Included here is his take on how in these fractious times, RCP members don’t have the right to choose who will lead them as this responsibilities fall on fellows of the college.

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Income Protection: What NHS Doctors Need to Know

Whenever ‘insurance’ comes up, it’s easy to tune out—but the On-Call team won’t let this critical issue slip by.

Doctors invest years in training to secure their income, yet few consider the financial impact if illness or injury stopped them from working. This risk is particularly serious for doctors with big mortgages, children, or other dependents.

We don’t need financial planners to tell us this, but we often dismiss this topic the moment it is raised because we don’t think it will ever happen to us. In reality, it is more common than we believe.

Many NHS doctors assume their employer's sick pay will suffice during illness or injury. However, NHS sick pay is limited and only covers up to 70% of gross earnings. Maximum NHS sick pay entitlement is 6 months full pay and 6 months half pay after you have given 6 years of service - That’s just one year of partial income support. Any long-term illness that lasts longer than 12 months is assessed on an individual basis. This is where Income protection insurance can come in… Don’t be caught unprepared.

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