When faced with decisions that involve life-threatening conditions and potentially life-altering treatments, many physicians would choose different treatments for themselves than they would recommend to patients, according to a study published April 11 in the Archives of Internal Medicine.
The results of the study, which involved hypothetical illnesses and treatment choices, indicate that the "very act of making a recommendation" changes the ways that physicians think about and weigh medical choices, explained Dr. Peter A. Ubel of Duke University, Durham, N.C., and his coauthors.
"When physicians make treatment recommendations, they think differently than when making decisions for themselves," the study said. "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" (Arch. Intern. Med. 2011;171:630-4).
The study’s authors chose two random samples of U.S.-based general internists and family medicine physicians and presented each with one of two hypothetical scenarios. In each scenario, one alternative offered a lower risk of mortality in exchange for a life-altering treatment complication.
In the first scenario, which involved a diagnosis of colon cancer, the 242 physicians surveyed each were offered a choice between two different surgeries. About half the physicians were told the choice was for them, while the other half had to choose what to recommend to a patient.
The first surgery would cure colon cancer without any complications in 80% of patients, while it would not cure the cancer in 16% of patients, leading to death within 2 years. The remaining 4% of patients would be cured of their colon cancer, but would experience one of four side effects: a colostomy, chronic diarrhea, intermittent bowel obstruction, or a wound infection.
The second surgery would cure colon cancer without complications in 80% of patients, while 20% of patients would not be cured and would die within 2 years.
"The best choice in this circumstance depends on the relative value a given patient places on avoiding these complications versus reducing his or her chance of death," the study said.
When asked which surgery they’d prefer for themselves, 37.8% chose the second procedure, with its higher mortality rate but lower risk of complications. When asked which procedure they’d recommend to patients, however, only 24.5% of the physicians surveyed recommended the second procedure.
In the second hypothetical scenario, 698 physicians were asked to choose between two situations potentially involving an immunoglobulin treatment for a hypothetical new strain of avian influenza. One group of physicians was asked to imagine that they had been infected with the virus, while the second group was asked to imagine that a patient had been infected.
The physicians were told that people who contracted the flu virus had a 10% death rate from the flu and a 30% hospitalization rate, with a 1-week average length of stay. Meanwhile, they also could choose a new immunoglobulin treatment for the avian flu.
That treatment had been tried out in several hundred volunteers in both Asia and Europe, and cut the chances of adverse events from the virus in half – meaning there would be a 5% death rate and a 15% hospitalization rate. However, the treatment would cause death in 1% of patients, along with permanent neurological paralysis – typically of the lower extremities – in 4% of patients.
As in the hypothetical colon cancer scenario, physicians presented with the avian flu scenario more often chose the treatment with a higher death rate for themselves: 62.9% chose to forgo the potentially lifesaving benefits of immunoglobulin treatment to avoid the adverse effects associated with that treatment. However, only 48.5% said they would recommend the immunoglobulin treatment for one of their patients who had contracted avian flu.
It’s obvious that the physicians in the study placed different weights on treatment outcomes when considering them for patients than they did when considering the various options for themselves, the study’s authors said. Physicians were less susceptible to psychological processes that potentially interfere with optimal decision-making when they made recommendations to hypothetical patients, the study said.
However, the study doesn’t suggest that physicians always make better, less-biased decisions for their patients than they would for themselves, the investigators wrote. "Indeed, the best choice in each of the two study scenarios is debatable," they said.
The study was funded by grants and awards from the National Institutes of Health, the American Cancer Society, the National Science Foundation, and the Robert Wood Johnson Foundation. The authors reported no disclosures.