OUR OPINION: PATIENTS NEED MORE DISCLOSURE, STRICT CONFLICT RULES When a doctor gives advice to a patient, there should not be even a smidgen of doubt that the advice is based primarily on what is best for the patient. Yet conflict rules are so lax that doctors often have relationships - personal or financial - with laboratories, drug companies, medical suppliers and others that could affect their advice to patients or, heaven forbid, the medical outcome of the drugs or procedures they recommend. Girlfriend hired This is why the situation with University of Miami cardiologist Alberto Interian Jr., who is romantically involved with a sales representative of a company that sells heart-implant devices, is so disturbing. A Miami Herald story last week described how Dr. Interian asked vendors of different brands of the device to hire his girlfriend - and appeared to shift business to the company that agreed. Audits by UM and by Jackson Memorial Hospital, where Dr. Interian also practices, documented a sharp rise in sales of the device to the company the woman represented. Investigators for the Miami-Dade County Commission on Ethics and Public Trust found that the relationship constituted ``unethical behavior.'' However, the commission didn't file a formal complaint because it lacks jurisdiction to discipline a UM employee. As for UM, the school has demoted Dr. Interian and has since tightened its ethics rules. UM's policy now discourages personal relationships that can create a potential conflict. In a telephone conversation, Dr. Interian adamantly defended his behavior, saying that he disclosed the personal relationship to Jackson officials. Besides, he said, ``Most of my patients know about the relationship . . . and they haven't said a thing about it.'' Dr. Interian is a well-known and highly regarded expert in cardiac-rhythm ailments. His situation points out how difficult it can be to separate a doctor's personal interests from the interests of patients. Patients are likely to develop a bond with their doctor, and to trust him, long before they ever become aware of a doctor's financial connections or personal ties with vendors and drug companies. Financial reward This is why it is important for medical gatekeepers - hospitals, medical associations, healthcare providers, state and federal governments and the doctors themselves - to identify and discourage potential conflicts and require that doctors disclose their personal and financial ties. UM is not alone in trying to fashion policies - albeit belatedly in this instance - that regulate doctors' behavior. Reformers and healthcare providers nationwide worry that a doctor's advice might be influenced more by the potential of a financial reward than what is best for patients. Doctors interact with patients when they are desperate, sick, in pain or otherwise vulnerable. Patients need the protection of greater disclosure and tougher ethics rules.