When making treatment recommendations to patients, physicians change the way they think about medical choices for themselves, according to a survey study published in the April 11 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. Researchers believe a "better understanding of this thought process will help determine when or whether recommendations improve decision making."
Investigators posed participating clinicians with one of two clinical scenarios. The use of hypothetical situations allowed researchers to focus on well-established cognitive biases; by avoiding scenarios that mirror real-world decisions, they avoided having their results influenced by factors such as habit, convention, or past experience, according to the paper.
In one scenario, doctors were asked to choose between two surgical treatments for colon cancer. Both options had the same success rate, but one had higher mortality and fewer side effects; the second had a lower death rate and some adverse effects.
When asked to imagine they had received the cancer diagnosis, 37.8% of physicians chose the surgical procedure with a higher rate of death, but a lower rate of adverse effects. Conversely, when asked to make a recommendation for a patient, only 24.5% of physicians chose this option.
The other scenario asked physicians to imagine a new strain of avian influenza had just arrived in the United States. One group of physicians was asked to imagine they had been infected; the other group was asked to imagine a patient was infected. The only available treatment was an immunoglobulin treatment, without which persons who contract flu have a 10% death rate and a 30% hospitalization rate with an average stay of 1 week. The treatment would reduce the rate of adverse events by half, but it also causes death in 1% of patients and permanent neurological paralysis in 4% of patients.
When imagining they had been infected, 62.9% of physicians chose to forgo immunoglobulin treatment; when imagining that a patient had been infected, only 48.5% of physicians recommended not getting the treatment.
"Our study does not suggest that physicians always make better decisions for others than they would make for themselves. Sometimes, focusing on a broad array of relevant factors is essential to selecting the optimal choice," the authors write. "Our study demonstrates that physicians’ decisions are significantly influenced by their perspective—they make different decisions for themselves than they recommend to others. In both our scenarios, these differences led physicians to recommend the higher-survival option to patients more often than they chose it for themselves."