Conflicts of interest exist in nearly every clinical practice. The ethical work is not to pretend you have none but to recognize them, disclose appropriately, and manage them through structural responses. Conflicts left unaddressed shape care in ways that disadvantage patients; conflicts addressed openly can often be managed without compromising clinical work.
Financial conflicts. Pharmaceutical company relationships — speaker bureaus, consulting, research funding. Ownership interests in treatment programs you refer to. Compensation structures that incentivize specific prescribing or procedures. Each can shape clinical decisions unconsciously even when the clinician believes they're being purely objective. The Open Payments database in the US makes substantial financial relationships publicly visible.
Personal conflicts. Treating intimates — family members, close friends, employees. Romantic feelings toward patients. Personal investment in specific clinical outcomes. Treating people you have other relationships with compromises clinical judgment in ways even the clinician often can't fully appreciate.
Professional conflicts. Dual roles — being both the patient's therapist and forensic evaluator on the same case. Being researcher and treating clinician for the same patient. Being institutional administrator and clinician overseeing your own work. These create competing obligations that can't always be resolved cleanly.
The standard ethical responses. Recognize the conflict. Disclose to relevant parties (patient when prescribing a drug from a company you have relationship with; institution per disclosure requirements; sometimes specific to the situation). Manage through structural means — recusal when appropriate, oversight, additional scrutiny, sometimes transferring the case.
Always-prohibited: Treating intimates in formal psychiatric capacity. Sexual or romantic relationships with current or recent patients. Financial business relationships with patients. Significant gifts to or from patients. These don't have appropriate management through disclosure; they shouldn't exist.
The reflective practice question: "Would my decision be different if I didn't have this relationship/interest?" If the answer is even possibly yes, the conflict is affecting care, and it needs addressing — not just disclosing.