Doctors Push Treatments They Would Not Accept for Themselves: JAMA Study

Doctors are not superhuman. They don't possess super wisdom—and they don't have the right to make decisions for patients, except in emergencies. This JAMA study demonstrates why.

by Heidi Stevenson

11 April 2011

When your doctor suggests a treatment, it might be a good idea to ask, "Would you let a doctor do that to you?" And watch for body language to indicate lying. The chances are fairly good that, if he says he would, he's being disingenuous. A new study demonstrates that many doctors would not accept many of the treatments that they fob off on patients.

The Archives of Internal Medicine, a publication of the Journal of the American Medical Association, published a study of what doctors would do themselves, as opposed to what they tell their patients. The results are stunning. Peter Ubel of Duke University, the first listed study author, stated:

When physicians make treatment recommendations, they think differently than when making decisions for themselves.

The authors sent two different surveys to two groups of doctors. Each survey defined a hypothetical diagnosis with two types of hypothetical treatments. They were asked which of the two treatments they would accept for themselves and which they would tell their patients to have.

The results were stunning. In one scenario, 500 doctors were asked, if they'd been diagnosed colon cancer, which treatment they'd have. Both surgeries would cure 80% of the cases, however:

• The first surgery would result in a higher death rate, but fewer adverse effects.
• The second surgery would have a lower death rate, but a small percentage of patients would require colostomies or suffer from chronic diarrhea, intermittent bowel obstruction, or wound infection.

Of the 500 doctors who were sent this survey, 242 (48.4%) responded. Of the responses, 37.8% of the doctors would choose the surgery that results in a higher death rate with fewer adverse effects, but only 24.5% would advise their patients to have the same surgery.

A similar scenario was posed regarding contracting an avian influenza. The hypothetical treatment options offered were:

• An immunoglobulin treatment that would reduce the rate of flu-induced adverse events by half, but would cause death in 1% of patients and permanent neurological paralysis in 4% of them.
• No treatment, resulting in a 10% death rate and a 30% hospitalization rate with an average stay of one week.

698 of the 1600 flu-related surveys were returned. 62.9% of the doctors said that they would opt for no treatment, while only 48.5% would choose to opt for no treatment for their patients.

The results can be summarized like this: When they're the potential patients, doctors tend to consider the risk of adverse treatment effects to be more critical than the risk of outright death. Yet, their recommendations to patients—which, as many who have undergone medical treatments can avow—are significantly more likely to be for the treatments with a greater danger of disabilities and lower likeliness of death.

The study's lead researcher, Ubel, stated:

In both our scenarios, these differences led physicians to recommend the higher-survival option to patients more often than they chose it for themselves. Our study demonstrates that physicians' decisions are significantly influenced by their perspective; they make different decisions for themselves than they recommend to others.

Obviously, many doctors think of themselves differently than they do their patients. Their idea of risk for patients is entirely different than their perception of it for themselves. Apparently, quality of life factors in as less significant for patients than for doctors...in their minds.

Adverse effects from treatments are taken far more seriously when the potential patient is the doctor. Whether the difference in motivation is a result of viewing patients as somehow different from them or some other reason is undetermined by the study. That, though, could prove to be revealing. Do they tend to believe that patients' quality of life is less important than their own? Or is there another reason?

Many of you have probably seen the 1991 film, "The Doctor", starring William Hurt playing a high-powered physician who treated patients callously and taught his medical students to do the same, assuring them that it was the best way to provide the best treatment. Suddenly, though, he found himself on the other side of the coin, a patient with cancer. In that situation, he discovered what it's like to be treated as an object by the medical system, to be given little or no choice in what was done to him. He even asked a doctor, whom he'd considered beneath contempt for his caring way with patients, to do the surgery. In the end, he became a more caring doctor, changing his treatment style dramatically. It was a true story; the book had been written by the doctor to whom it happened.

No doctor should presume to make these decisions for us. The presumption that they should is hubris. The relative risks are personal. They don't live with the results. For any doctor to believe that he should tell us what to do, rather than provide us with the best possible information about the choices, including the risks, is nothing short of playing god.

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