"Long before it's in the papers"
January 27, 2015


Docs’ own treatment choices differ from what they advise patients, study finds

April 12, 2011
Courtesy of JAMA and Archives Journals
and World Science staff

Doc­tors’ treat­ment choices for them­selves of­ten dif­fer from those they would re­com­mend to pa­tients, ac­cord­ing to a new stu­dy.

Pre­sented with hy­po­thet­i­cal med­i­cal sce­nar­i­os, doc­tors re­spond­ing to a sur­vey tended to choose dif­ferent so­lu­tions for them­selves than what they said they would ad­vise for pa­tients. 

Doc­tors’ treat­ment choices for them­selves of­ten dif­fer from those they would re­com­mend to pa­tients, ac­cord­ing to a new stu­dy. (Im­age cour­tesy NIH)

The treat­ments doc­tors pick­ed for them­selves were not clearly bet­ter or worse, said the re­search­ers con­duct­ing the survey, nor were these choices ob­vious­ly more or less ag­gres­sive through­out the sur­vey.

They were just dif­ferent.

“We must now rec­og­nize that the very act of mak­ing a rec­om­menda­t­ion changes the way physi­cians weigh med­i­cal al­ter­na­tives,” wrote the re­search­ers, Pe­ter A. Ubel of Duke Un­ivers­ity in Dur­ham, N.C., and col­leagues, re­port­ing their re­sults in the April 11 is­sue of the jour­nal Ar­chives of In­ter­nal Med­i­cine.

They sur­veyed two sam­ples of U.S. pri­ma­ry care doc­tors, pre­sent­ing each with one of two sce­nar­i­os.

In the first, 500 doc­tors were asked to im­ag­ine that ei­ther they or one of their pa­tients faced a choice be­tween two opera­t­ions for co­lon can­cer. Both cured the dis­ease 80 per­cent of the time. The dif­ference was that one had a low­er death rate, but a much high­er risk of se­ri­ous side ef­fects. Of the al­most half of doc­tors who re­turned the ques­tion­naire, 37.8 per­cent chose the high­er death-rate pro­ce­dure for them­selves, but only 24.5 per­cent chose the same op­tion for pa­tients.

The sec­ond sce­nar­i­o asked 1,600 physi­cians to im­ag­ine either that they were in­fected with a new strain of avi­an flu, or that a pa­tient was struck with it. One treat­ment op­tion was an “im­munoglob­u­lin ther­a­py, which causes death in one per­cent of pa­tients and per­ma­nent pa­ral­y­sis in four per­cent—but saves them from a 10 per­cent chance of dy­ing and 30 per­cent chance of wind­ing up in the hos­pi­tal for an av­er­age of one week. Of the 43.6 per­cent of sur­veyed do­cotrs who re­sponded, 62.9 per­cent chose to for­go the treat­ment for them­selves, but only 48.5 per­cent rec­om­mended that their pa­tient for­go it.

“In con­clu­sion, when physi­cians make treat­ment rec­om­menda­t­ions, they think dif­ferently than when mak­ing de­ci­sions for them­selves,” Ubel and col­leagues wrote. “In some cir­cum­stances, mak­ing rec­om­menda­t­ions could re­duce the qual­ity of med­i­cal de­ci­sions. In at least some cir­cum­stances, how­ev­er, such as when emo­tions in­ter­fere with op­ti­mal de­ci­sion mak­ing, this change in think­ing could lead to more op­ti­mal de­ci­sions.”

* * *

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Doctors’ treatment choices for themselves often differ from those they would suggest to patients, according to a new study. Presented with hypothetical medical scenarios, researchers found, doctors responding to a survey tended to choose different solutions for themselves than what they said they would advise for patients. The treatments doctors picked for themselves were not clearly better or worse than those recommended for patients, the investigators said. Nor were the personal choices clearly more or less aggressive than those made for patients. They were just different. “We must now recognize that the very act of making a recommendation changes the way physicians weigh medical alternatives,” wrote the researchers, Peter A. Ubel of Duke University in Durham, N.C., and colleagues, reporting their results in the April 11 issue of journal Archives of Internal Medicine. They surveyed two samples of U.S. primary care doctors, presenting each with one of two scenarios. In the first, 500 doctors were asked to imagine that either they or one of their patients faced a choice between two operations for colon cancer. Both cured the cancer 80 percent of the time. The difference was that on had a lower death rate, but a much higher risk of serious side effects. Of the almost half of doctors who returned the questionnaire, 37.8 percent chose the higher death-rate procedure for themselves, but only 24.5 percent chose the same option for patients. The second scenario asked 1,600 physicians to imagine a new strain of avian flu had just hit America. One group was asked to pretend they were infected; the other, that a patient was infected. One treatment option was an “immunoglobulin” therapy, which causes death in one percent of patients and permanent paralysis in four percent—but saves them from a 10 percent chance of dying and 30 percent chance of winding up in the hospital for an average of one week. Of the 43.6 percent of surveyed docotrs who responded, 62.9 percent chose to forgo the treatment for themselves, but only 48.5 percent recommended that their patient forgo it. “In conclusion, when physicians make treatment recommendations, they think differently than when making decisions for themselves,” Ubel and colleagues wrote. “In some circumstances, making recommendations could reduce the quality of medical decisions. In at least some circumstances, however, such as when emotions interfere with optimal decision making, this change in thinking could lead to more optimal decisions.”