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The doctor-patient relationship is based on trust. When you enter that examination room and the door closes, you want to believe it's just you and your physician, free of outside influences, working as a team to keep you healthy. The reality is more complicated, of course, and a new survey shows just how often patients don't know who's potentially influencing their doctors.According to the survey, two-thirds of Americans who visited a doctor in the past year had seen one who'd taken payments or gifts from pharmaceutical and medical device companies. Those who'd visited certain specialists were even more likely to find one who'd taken payments: 85 percent among those who saw an orthopedic surgeon, and 77 percent among those who'd seen an obstetrician or gynecologist. Yet few patients (just 5 percent) knew whether their own doctor received payments.The survey covered more than 3,500 adults, linking their responses to data from Open Payments, a database established under the Affordable Care Act to report industry payments to physicians. The amount of the payments varied. Researchers noted, however, that in Open Payments all physicians averaged $193 in payments and gifts. Those linked to patients in the survey, however, received a median of $510—more than two-and-a-half times as much.That may not sound like much compared to the average doctor's salary, but it indicates that most people are seeing doctors who receive unusually high payments, particularly among specialists. Yet many respondents indicated they were even aware that such payments happen in healthcare. Meanwhile, those who did know about the practice mistakenly believed their own doctors had not taken payments or gifts.Open Payments was established to bring much-needed transparency to how money flows from industry sources to doctors, but this survey suggests that so far, few patients are taking advantage of it. In three states (Minnesota, Massachusetts, and Vermont), open-records laws mean that information about doctor payments has been available for some time. According to the survey, patients in those states are about half as likely to see doctors who've taken payments. The authors suggest that simply making such data transparent may discourage doctors from taking payments.Transparency may cause doctors to shy away from industry gifts, but it ultimately puts the onus for being informed squarely on the patient. Right now, at least according to this survey, most people are not digging into their doctors' information. That fact the information is even available, though, is a requirement of the Affordable Care Act, meaning that if the act is repealed, patients may be even more in the dark about just who is paying their doctors.