Physician, Heal Thyself

Treatment advice depends on perspective


A patient who can’t decide between two available treatments asks his doctor: “What should I do?” Another patient, torn between the same two treatments, asks: “Doctor, what would you do if you were me?”

Will those two patients get the same answer? That question, posed by researchers from Duke and the University of Michigan in a national survey of physicians, found doctors often recommend different treatments for patients from what they would choose for themselves.

In the study, the researchers conducted a randomized experiment asking some physicians to make a recommendation to a patient seeking advice, while other physicians were asked what they themselves would choose as a patient facing the same health-care decision.

Doctors frequently advised patients to pursue treatments with higher rates of side effects and lower mortality rates, while choosing treatments with lower rates of side effects and higher mortality rates for themselves.

The researchers say that the recommendations physicians made to patients represented the rational course of treatment. “Our research found that people felt living with a colostomy or being paralyzed was better than dying. From that perspective, the ‘right’ decision is to take the risk of side effects and reduce the chances of dying,” says Peter Ubel, a professor of public policy studies and the Jack O. Blackburn Professor of marketing at the Fuqua School of Business.

“When making recommendations to patients, physicians can push aside any emotions that would lead them astray,” Ubel says. “But those emotions may loom large when a doctor is deciding for him[self] or herself. In other words, the act of giving advice to others may reset the balance between emotion and reason.”

Ubel adds, “Many physicians are biased by their own backgrounds, valuing things that patients don’t necessarily value, or they can even be influenced by financial and professional conflicts of interest that can skew judgment.”


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