There is a body of literature on how physicians think, i.e.- clinical diagnostic reasoning. A good read is Dr. Jerome Groopman's How Doctor's Think.
A recent paper published in the Archives of Internal Medicine explores decision making from a different perspective.
The title is quite telling: Physicians Recommend Different Treatments for Patients Than They Would Choose for Themselves.
The investigators explore the ways that physicians' decisions are influenced by the act of making a recommendation. The study surveyed 2 representative samples of US primary care physicians—general internists and family medicine specialists. Physicians were 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. Physicians were randomized to indicate which treatment they would choose if they were the patient or they were recommending a treatment to a patient.
For the 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. 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.
Physicians in this study sample preferred treatments with lower chance of adverse effects, despite the potential increase in mortality. The act of making a recommendation changes the ways that physicians think regarding medical choices. This needs to be studied further.
Patient decision making is highly impacted by information asymmetry. A physician's treatment recommendation is highly valued.
In addition to primum non nocere (first, do no harm), perhaps we should consider "recommend unto others as we would recommend unto ourselves'
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| Source: BBC |
The title is quite telling: Physicians Recommend Different Treatments for Patients Than They Would Choose for Themselves.
The investigators explore the ways that physicians' decisions are influenced by the act of making a recommendation. The study surveyed 2 representative samples of US primary care physicians—general internists and family medicine specialists. Physicians were 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. Physicians were randomized to indicate which treatment they would choose if they were the patient or they were recommending a treatment to a patient.
For the 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. 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.
Physicians in this study sample preferred treatments with lower chance of adverse effects, despite the potential increase in mortality. The act of making a recommendation changes the ways that physicians think regarding medical choices. This needs to be studied further.
Patient decision making is highly impacted by information asymmetry. A physician's treatment recommendation is highly valued.
In addition to primum non nocere (first, do no harm), perhaps we should consider "recommend unto others as we would recommend unto ourselves'
