Doctors often make different medical recommendations for their patients than they would for themselves, according to a new study.
Nearly 38 percent of doctors said they would rather undergo a treatment that comes with a higher risk of death but fewer side effects, compared with a treatment that has a lower risk of death but more side effects. But only 24.5 percent of doctors said they would recommend the same treatment for their patients, the study said.
The results show that “when physicians make treatment recommendations, they think differently than when making decisions for themselves,” Duke University researchers wrote in the study.
Researchers said it’s possible that the simple act of making a recommendation could cause doctors to consider certain treatment outcomes more heavily than if they were just making a personal decision.
It’s also possible that when making recommendations for others, doctors have a bias against treatments that could also cause harm — they would sooner the actual disease or illness cause the harm, than the supposedly “good” treatment, researchers said.
But when choosing for themselves, doctors don’t have to justify the explanation to anyone and therefore may be more subjected to personal bias, they said.
The study was published today (April 11) in the journal Archives of Internal Medicine.
Study researcher Dr. Peter A. Ubel and his colleagues at Duke University surveyed two samples of U.S. primary care physicians, and presented each with one of two clinical scenarios.
Scenario No. 1: Colon cancer treatment
In the first scenario, 242 physicians were asked to imagine that either they or one of their patients had just received a diagnosis of colon cancer and faced a choice of one of two operations to treat the cancer.
Both surgeries cured the colon cancer in 80 percent of patients, but one surgery had a higher death rate, though fewer other adverse effects, whereas the second surgery had a lower death rate but a small percentage of patients experienced chronic diarrhea, intermittent bowel obstruction or a wound infection, or had to undergo a colostomy (a surgical procedure that involves bringing one end of the large intestine through the wall of the abdomen).
When asked to imagine they had received the cancer diagnosis, 37.8 percent of physicians chose the surgical procedure with a higher rate of death, but a lower rate of side effects. But when asked to make a recommendation for a patient, only 24.5 percent of physicians chose this option, the study said.
Scenario No. 2: Preventing the avian flu
In the second scenario, 698 physicians were asked to imagine that a new strain of avian influenza had just arrived in the United States. One group of physicians was asked to imagine they had been infected, and the other group was asked to imagine that his or her patient was infected, according to the study.
Only one treatment is available for this strain of influenza, and without it, there would be a 10 percent increased risk of death and a 30 percent increased risk of at least a one-week hospitalization. The treatment would halve the risk of adverse events associated with the flu, but also cause death in 1 percent of patients and permanent neurological paralysis in 4 percent of patients, the study said.
Nearly 63 percent of physicians chose to forgo the treatment when imagining they had been infected, the study said. But when imagining that a patient had been infected, only 48.5 percent of physicians recommended not getting the treatment.
“In debating when it is appropriate for physicians to make treatment recommendations to their patients, we must now recognize that the very act of making a recommendation changes the way physicians weigh medical alternatives,” the researchers wrote.
Pass it on: Doctors may not always choose the same treatment options for their patient as they would for themselves.
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