Disclosure of bias should decrease the weight that patients put on their physicians’ recommendations…but apparently, according to research, it doesn’t.
A doctor’s guidance may reassure us more than we realize -especially if she says she is likely to recommend treatment in her field of expertise, known as “specialty bias.”
Doing research in a real-world health care setting, a Cornell expert and her colleagues have found that when surgeons revealed their bias toward their own specialty, their patients were more likely to perceive them as trustworthy. And patients are more apt to follow their recommendation to have surgical treatment. The research was published this week in the Proceedings of the National Academy of Sciences.
The study has important implications for professional advisers of any stripe and policymakers who deal with disclosure rules, said Sunita Sah, a physician and assistant professor of management and organizations at Cornell’s Samuel Curtis Johnson Graduate School of Management.
“If an adviser discloses a bias, it should alert the recipient to some uncertainty regarding the quality of the advice. ‘Perhaps I need to discount this a little bit.’ Disclosure of bias, if anything, should decrease the weight that patients put on their physicians’ recommendations,” said Sah, an expert on conflicts of interest and disclosure. “But, instead, we find that patients report increased trust and they are more likely to take the physician’s treatment than patients who do not hear their physician disclose a bias.”
Sah and her colleagues based their findings on 219 transcripts of conversations between surgeons and male patients in four Veterans Affairs hospitals in which the surgeon revealed a diagnosis of localized prostate cancer to the patient. While discussing treatment options, some surgeons freely admitted to having a bias toward their own specialty, with statements such as, “I’m a surgeon, so I’m biased toward recommending surgery.” Patients who heard their surgeon disclose their specialty bias were nearly three times more likely to decide to have surgery than patients who did not hear their surgeons disclose a bias.
The researchers also conducted a randomized lab experiment. In this study, 447 men watched video clips of an actor portraying a surgeon, who described two treatment options: surgery and radiation. In the “disclosure” group, the men heard the actor disclose his bias towards surgery, similar to the surgeons in the Veteran Affairs hospitals. The control group saw the same video, except for the bias disclosure. The men who heard the disclosure were more likely to choose surgery than the control group and reported higher trust in the doctor’s expertise.
Sah and her colleagues also found that surgeons who disclosed bias toward their specialty or discussed a potential meeting with a radiologist oncologist for radiation treatment tended to give stronger recommendations for surgery.
“Bias disclosure can have a profound influence on adviser recommendations and the choices their advisees make,” said Sah. “Professional advisers and policymakers should implement such disclosures with care.”