Physicians May Heal Themselves Differently

This article highlights quality of life versus quantity of life.  I believe quality of life is always the most important factor.  If you agree, this maybe something that you want to make sure your physicians understand when discussing any procedures with them as they are surely taking it into consideration for themselves.

Source: Wall Street Journal April 12 2111

Physicians May Heal Themselves Differently


Doctors weigh treatment options differently when they are deciding for themselves and when they are treating patients, according to a new study.

Doctors were more likely to opt for treatments with a higher chance of death—but lower risk of serious side effects—for themselves than for their patients in a survey of 940 primary-care physicians evaluating one of two hypothetical medical scenarios.

The results suggest that the “act of making a recommendation changes the psychological processes influencing their decisions,” write the authors, from Duke University and the University of Michigan.

It also means patients should be sure their physicians understand their values and should ask their doctors about the reasons behind their recommendations, says physician Peter Ubel, a study author and professor at Duke’s Fuqua School of Business and Sanford School of Public Policy.

The study, published in the Archives of Internal Medicine, presented one of two clinical scenarios. One involved colon-cancer surgery and the other was about treatments for avian flu. Physicians were randomly chosen to either weigh the options for their own treatment or to make a recommendation to a patient.

One option in the colon-cancer scenario was an operation that completely cures 80% of patients with no complications, fails to cure 16% of patients —meaning they will die within two years—and cures but leads to complications such as a colostomy or chronic diarrhea for the remaining 4%. The other option was a different surgery that also cures 80% of patients without any complications, but fails to cure 20% of patients.

The option with a lower risk of death may seem to be the logical choice. But 38% of physicians tasked with weighing the decision for themselves picked the treatment with the higher death rate—preferring not to risk complications. Only 25% of the physicians in the other group said they would recommend a patient go that route. In the avian-flu scenario, 63% picked the treatment with the highest chance of death for themselves, with 49% recommending it for patients.

The results don’t necessarily mean that physicians always make less risky decisions for their patients than for themselves, says Dr. Ubel. It does mean the mindsets for those decisions are subject to different psychological biases. He recommends patients “don’t ask for advice until the doctor understands you a little better,” including how you weigh issues such as quality of life versus length of life.

And, he says, when a physician gives advice, ask why he or she is making that recommendation, to ensure the reasons align with your preferences, he says.

Similar research among non-physicians shows that they, too, will come to different conclusions in medical scenarios in which they’re deciding for themselves and those in which they have been told to decide for others.

“When you put on the doctor hat,” it changes how you decide, says Dr. Ubel.

A physician’s recommendation rooted in his or her knowledge of the situation is more helpful for patients than a neutral recitation of options, says Timothy Quill, one of the authors of a commentary accompanying the study, and a professor of medicine, psychiatry and medical humanities at the University of Rochester School of Medicine and Dentistry.

He cautions, however, that doctors should consider “the patient’s values, not [their] own values or what [they] think they should be doing as a physician.”

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