“In My Place, Doctor, What Would You Do?”

It seems to me quite feasible that many people, when confronted with a difficult medical decision, would ask their physician: “What would you do, doctor?”  After all, a physician ought to be in the best position to give well-informed advice on the best course to take in choosing the best treatment.  And the family physician should know the relevant patient and family circumstances.  But a survey carried out by Duke and Ann Arbor researchers, and published in the Archives of Medicine, suggests the advice you get from the physician may differ from his or her own convictions . . .

Two samples of US primary care physicians – also called general or family practitioners –were presented with one of two hypothetical clinical scenarios.  One involved choosing between two treatment options for colon cancer, and the other between two options for treating bird flu (avian influenza, H5N1, which carries a 50% death rate). In both cases, one option had a high rate of side effects but a low death rate, and the other had a higher risk of death but a low rate of side effects.  The doctors were asked to make a recommendation for a patient regarding the options, answering the question “What should I do, doctor?”, or were asked what they would choose for themselves if they were the patient and were asked “Doctor, what would you do if you were me?”

Among the 242 physicians asked to consider the colon cancer scenario, 37.8% chose the treatment with the high death rate/low side effects for themselves, but only 24.5% recommended this treatment for a hypothetical patient. 

Among the 698 physicians asked about the bird fly options, 62.9% selected the high death rate/lower side effects for themselves, but only 48.5% recommended this for a hypothetical patient. 

What do these results show?  The researchers conclude “The act of making a recommendation changes the way physicians think regarding medical choices.”  Explaining further, they bring up the role played by emotion.  Patients without benefit (!) of a doctor’s opinion were found to prefer bad side effects (e.g. living with a colostomy, or being paralyzed) to risking death. When asked to make a recommendation, doctors can afford to be objective, and will more likely opt for the decreased risk of dying.  But when deciding ‘for themselves’, doctors’ emotional reactions to the thoughts of potentially unpleasant side effects resets the balance between emotion and reason, and their advice swings to preference for the higher risk of death/lower side effect options.

The bottom line is that doctors may not always be as objective as you might think.  And they may bring into play what they think you should do.  This means your doctor should have found time to become well-informed about your family and other life circumstances, and be able to ‘tailor’ his/her advice accordingly.