Physicians recommend treatments with higher survival rates for their patients, but they make more mental mistakes when they are the patient and have to choose for themselves.
Psychologists know that when people make decisions for others, they are dispassionate enough to be less swayed by extraneous factors. Even toddlers make less impulsive decisions for others than they do for themselves.
Researchers surveyed general internists and family medicine specialists about two scenarios, each with two treatment alternatives. Both outcomes involved a choice between surviving a fatal illness but with sometimes crippling outcomes. Physicians were randomized to groups in which they imagined themselves as the patient facing the decision, or in which they were recommending an option to a patient.
ACP Member Peter A. Ubel, MD, led the study, which appeared in the Archives of Internal Medicine on April 11.
The first hypothetical scenario involved two types of surgery for colon cancer. The first type of surgery cures colon cancer without any complications in 80% of patients, results in death within two years in 16%, and 1% apiece would experience a colostomy, chronic diarrhea, intermittent bowel obstruction or a wound infection. The second type of surgery cures 80% without complications, or results in 20% mortality within two years.
Among 242 respondents, 37.8% chose the treatment with a higher death rate for themselves but only 24.5% recommended this treatment to a hypothetical patient (P=.03).
A second, larger survey outlined a hypothetical new strain of avian influenza. Again, physicians were randomized to scenarios in which they’d either been infected themselves or were advising patients who had been infected. People who contract the flu virus have a 10% death rate from the flu and a 30% hospitalization rate, with a 1-week average length of stay.
An immunoglobulin treatment was available that halves adverse events to a 5% death rate and a 15% hospitalization rate, with a 1-week average length of stay. However, it causes death in 1% of patients and permanent neurological paralysis in 4%. Authors noted this scenario includes an arguably dominant option of less mortality while introducing adverse effects that the vast majority of people consider preferable to death.
Among the 698 respondents, 62.9% chose the outcome with the higher death rate for themselves but only 48.5% recommended this for patients.
*This blog post was originally published at ACP Internist*