Physicians Recommend Different Treatments for Patients Than They Would Choose for Themselves

Methods We surveyed 2 representative samples of US primary care physicians—general internists and family medicine specialists listed in the American Medical Association Physician Masterfile—and presented each with 1 of 2 clinical scenarios. Both involved 2 treatment alternatives, 1 of which yielded a better chance of surviving a fatal illness but at the cost of potentially experiencing unpleasant adverse effects. We randomized physicians to indicate which treatment they would choose if they were the patient or they were recommending a treatment to a patient.

Results Among those asked to consider our colon cancer scenario (n = 242), 37.8% chose the treatment with a higher death rate for themselves but only 24.5% recommended this treatment to a hypothetical patient (21 = 4.67, P = .03). Among those receiving our avian influenza scenario (n = 698), 62.9% chose the outcome with the higher death rate for themselves but only 48.5% recommended this for patients (21 = 14.56,P < .001).

More on the Archives of Internal Medicine study.

Comments (5)

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  1. Bruce says:

    This is a problem with a very obvious solution. When your doctor recommends a course of treatment ask: What would you do if you were the patient.

  2. Devon Herrick says:

    It should not come as a surprise that physicians often recommend treatments different than they would choose. I sometimes take risks that I would not recommend others take merely so it wouldn’t be my fault if they had an adverse result.

  3. Vicki says:

    I think Bruce has the right solution here. Provided the doctor answers truthfully.

  4. Virginia says:

    I somewhat agree with Devon. Perhaps doctors are trying to protect their patients. However, who are doctors to think that their odds are any better? It seems like a lapse in judgment to me.

  5. Seamus Muldoon MD says:

    @ Bruce
    @ Vicki

    As a physician I am asked that question frequently. Since I am in a Pediatric field the question is phrased as “What would you do if it were YOUR child?” I do answer honestly, but I also qualify my answer by emphasizing that I am NOT them. I do not have the same life history, religious background, values, family situation, resources etc. etc. etc.
    This gets to the core of the whole Obamacare issue. Once you have third party payers of any kind, (most especially a federal government), decisions are taken out of the hands of the individual patient, and based on someone else’s value system. We MUST strive to put these decisions back in the hands of the patient.