Doctors often advise patients to opt for treatments that they would not necessarily choose for themselves if faced with the same alternatives, according to the results of a US survey published in a leading journal this week.

The survey found that doctors frequently advised patients to opt for treatments with higher rates of side effects and lower risk of death, but if they were in the patients’ shoes, they would choose treatments with lower rates of side effects and a higher risk of death.

Professor Peter Ubel and post-doctoral associate Andrea Angott of Duke University’s Fuqua School of Business and professor Brian Zikmund-Fisher of the University of Michigan, wrote about their survey in a paper that is published online this week in the Archives of Internal Medicine.

The researchers set out to investigate the ways that doctors’ decisions might be influenced by the act of making a recommendation.

They surveyed 2 representative samples of US primary care physicians, and presented each with one of two hypothetical clinical scenarios. One scenario involved choosing between two treatment options for colon cancer, and the other between two treatment options for bird flu.

For the two treatment options in both scenarios, one had a high rate of side effects but low rate of death, and the other had a low rate of side effects but higher risk of death.

The doctors surveyed were general internists and family medical specialists listed in the American Medical Association Physician Masterfile.

In each sample, they randomly selected which doctors would be asked to make a recommendation and which would be asked to choose as if they were the patient.

The doctors that were asked to make a recommendation were asked what they would say to a patient who can’t decide between two treatments, and asks the doctor “What should I do?”

The doctors that were asked what they would choose for themselves were asked which option they would select if they were the patient facing the same two options, thus tapping their response to “Doctor, what would you do if you were me?”

The results showed that:

  • Among the 242 doctors asked to consider the colon cancer options, 37.8% chose the options with the higher risk of death for themselves, but only 24.5% recommended this option to their hypothetical patient.
  • Among the 698 doctors asked to consider the bird flu options, 62.9% chose the options with the higher risk of death for themselves, but only 48.5% recommended it for their patients.

Ubel and colleagues concluded that:

“The act of making a recommendation changes the ways that physicians think regarding medical choices.”

“Better understanding of this thought process will help determine when or whether recommendations improve decision making,” they added.

In a press statement, Ubel suggested emotion was a big influencing factor.

In their own research about what patients wanted, they found people would prefer to live with a colostomy or be paralyzed, rather than risk death.

“From that perspective, the ‘right’ decision is to take the risk of side effects and reduce the chances of dying,” said Ubel.

But, the thought of experiencing the side effects yourself can give rise to emotions that make you push the “right” decision away.

When asked to make a recommedation, doctors, who are free from the side effects themselves, can be objective.

But when deciding for themselves, those emotions “may loom large” said Ubel.

“In other words, the act of giving advice to others may reset the balance between emotion and reason,” he added.

Other factors may also influence judgements when making recommedations, as Ubel noted:

“Many physicians are biased by their own backgrounds, valuing things that patients don’t necessarily value, or they can even be influenced by financial and professional conflicts of interest that can skew judgment.”

The consequence is your doctor may not always be as objective as you might imagine:

“Instead, the advice you get could depend on whether your doctor is thinking about what you should do, or instead thinking about what he or she would do in your situation.”

The American Cancer Society, the National Science Foundation and the National Institutes of Health funded the study.

“Physicians Recommend Different Treatments for Patients Than They Would Choose for Themselves.”
Peter A. Ubel, Andrea M. Angott, Brian J. Zikmund-Fisher.
Arch Intern Med. Vol. 171 No. 7, pp 630-634, published 11 April 2011.

Additional source: Duke News (11 April 2011). Written by: Catharine Paddock, PhD