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Physicians’ Treatment Recommendations

By April 18, 2011Commentary

A line of research has looked at physician recommendations and orders for patient treatment in light of what the physician would do for him or herself in the same situation.  Often physicians order more aggressive treatment than patients might want, particularly in end-of-life situations.  A study published in the Archives of Internal Medicine finds, however, that doctors may also attempt to make more conservative choices on behalf of patients.  The research was based on a survey of about 950 primary care physicians who were presented one of two scenarios.  (Archives Article)

In the first scenario physicians were presented with colon cancer treatment options which in one case would have a 20% chance of death and in another a 16% likelihood but a 4% chance of some unpleasant complication.  The doctors were randomized to making a recommendation for a patient or to making a decision on what to do for themselves.  When dealing with their own care, about 38% of the doctors chose the treatment with the higher death rate and lower side effects, but when making a recommendation for patients, only 25% did so.  Age, sex or volume of patient care did not affect how the physicians responded to the scenarios.

The second scenario involved the flu, with a treatment that would result in ten% of patients dying from the flu and another 30% having a one week hospitalization versus a treatment that would have 5% dying from the flu, 15% hospitalized for a week and another 1% dying from the treatment and 4% incurring permanent paralysis from the treatment.  In this scenario, 63% of physicians would choose to avoid the higher risks of adverse effects for themselves but would recommend that choice only 49% of the time for their patients.  It is not necessarily clear what the “best” choice would be in each of these scenarios, and the point of involving patients in decision-making is to help elicit their preferences.  Physician recommendations can be powerful influence on patient decisions, however, and this research indicates that physicians might make different choices for patients than for themselves.

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