Physicians will more likely select a treatment for themselves that is riskier and has a higher death rate but less chance of adverse complications—but they would recommend an opposite course for their patients, according to a study in the new issue of Archives of Internal Medicine.
The study, conducted by researchers from Duke University and the University of Michigan, asked physicians to choose between two treatment options for cancer and the flu – one with a higher risk of death and one with a higher risk of serious, lasting complications.
Of over 240 internists and family physicians responding to a survey involving a theoretical scenario involving colon cancer treatment, approximately 38% chose the treatment that carried a higher mortality rate but lower rate of adverse effects—and only 25% said they would recommend that option for a patient. Of almost 700 physicians who responded to a similar question about the avian flu, 63% chose the treatment with the higher-mortality rate and lower adverse-effect rate, while only 49% recommended the same option for a patient.
In an accompanying commentary on the study, physicians with the palliative-care program at the University of Rochester, NY Medical Center state wrote: “Physicians may be more able to imagine their patients’ abilities to adapt to significant disability than the patients themselves could, but only when considering the consequences for themselves can they imagine the level of suffering that might be a byproduct of an unfavorable outcome.”
The act of making a recommendation appears to change the ways the physicians think regarding medical choices, according to study researchers. Having a better understanding of the thought process that occurs can help determine when or whether recommendations improve decision making.
Do physicians unintentionally expect patients to tolerate side effects that they themselves wouldn’t choose to tolerate? Or is it a matter of malpractice fears and choosing the safer route for patients?