HEALTHCARE
April 27, 2011

Do As I Say, Not As I Do

Doctors would often choose different treatments for themselves than those they would recommend to patients. Why?

A new study reports that doctors would often recommend different treatments to their patients from what they’d chose for themselves. What does this say about the decision-making process in medicine?

In the new study, researchers asked 242 doctors to imagine a scenario in which either one’s patient or oneself was diagnosed with colon cancer. The doctors were asked to choose between two treatment options with the same cure rate.

Doctors may only consider the amount of potential suffering involved with long term side effects when they imagine themselves in the situation. This becomes an even bigger concern since priorities vary widely between people.

The first option had a higher death rate but fewer long term effects. The second had a lower death rate but greater chances for long term problems like chronic diarrhea, colostomy, intermittent bowel obstruction, and wound infection. When the doctors imagined treating a fictitious patient, they chose the second option more often (lower death rate, more long term risks). But when they imagined what they’d do for themselves, they chose the first option (higher death rate, fewer long term risks).

A second scenario posed a similar problem: almost 700 doctors had to decide whether they would prescribe medication for a fictional bird flu. Not treating it would lead to a 10% death rate and 30% hospitalization rate. Treating it with a drug would cut down these numbers by half, but the treatment itself would pose a 1% death risk, and 4% risk of paralysis. Similar to the first situation, doctors chose to give patients the medication more often than they would actually choose to take it themselves.

For both fictional scenarios, doctors favored choices with higher death risks but fewer long term effects for themselves — but not for their patients. The study shows that the decision-making process is quite different when one is considering oneself as opposed to another. But it does not show whether decision-making is any better or worse for the self or the other, since there was really no "right choice" in either of the scenarios.

The authors of an accompanying editorial point out that different "vantage points" can change how one views a situation. For example, doctors may only consider the amount of potential suffering involved with long term side effects when they imagine themselves in the situation. This becomes an even bigger concern since priorities vary widely between people, and quality of life may be much more important for some than for others. For this reason, it is crucial that patients and doctors discuss what is important to the patient, so that both parties are on the same page when they make major health decisions.

Whether doctors should make recommendations to their patients at all is a big topic of conversation right now. Some people feel that doctors should simply lay the options out on the table for the patient, and let the patient decide what to do. The results of this study make the debate even trickier by throwing another issue into the mix — whether doctors make better recommendations for themselves or for another. More research may help figure out how important medical decisions are best made, but in the meantime, being frank with one’s doctor about priorities, needs, wants, and fears is likely a good way to start.

The study was conducted by researchers at Duke University and the University of Michigan at Ann Arbor, and published in the April 11, 2011 issue of Archives of Internal Medicine. The editorial can also be found in this issue.

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