Doctors May Suggest Different Treatments For Patients Than For Themselves

Physician recommendations greatly influence the decisions patients make, but new research suggests that what your doctor advises isn't always what he or she would do personally.

In a study in the Archives of Internal Medicine, researchers presented general internists and family physicians with two different scenarios to test what they'd recommend for patients versus what they'd choose for themselves.

The differences, as the BBC reports, were pronounced:

Doctors were far more likely to opt for a therapy carrying a higher chance of death but better odds of side-effect-free survival, for example. But for their patients, doctors tended to pick a treatment that erred on the side of survival, regardless of the quality of life.

The double standard might come from doctors being able to push their emotions aside when dealing with patients.

"I think the doctors, when they were imagining themselves as the patient, were saying, 'Yes, there is a higher survival, but I don't want to put up with these horrible side effects,'" Dr. Peter Ubel of Duke University told WebMD. "On the other hand, when they are making recommendations for the patients, it is easier to push those emotions aside.''

Here's how the study worked. In the first scenario, doctors were asked to imagine that their patients had been diagnosed with colon cancer and had two options: Surgery 1 would cure cancer in 80 percent of the patients with no complications; 16 percent would not be cured and would die within two years; and the remaining 4 percent would be cured, but would have serious side effects like wound infection or chronic diarrhea. Surgery 2 would cure 80 percent of patients with no complications, but 20 percent would not be cured and would die within two years.

The study's authors explained that the two scenarios were selected because they involve a "trade-off between the risk of death and the chance of four surgical complications."

The results?

Of the 242 physicians who returned the colon cancer questionnaire, only 24.5 percent of the physicians said they'd recommend surgery two -- aka the procedure with the higher mortality rate -- for their patients. But when asked what they'd do personally, 37.8 percent of the physicians said they would opt for surgery two.

A similar pattern held up in a second scenario.

This time, primary care physicians were asked to imagine that a patient had contracted a new strain of avian flu for which there was an immunoglobin treatment available. Patients who declined the treatment faced a 10 percent mortality rate and 30 percent hospitalization rate for an average of one week. If patients opted to take it, their hospitalization and mortality rates would be cut in half, but the treatment would kill 1 percent of patients and result in 4 percent being permanently paralyzed.

Of the 698 physicians who responded, 48.5 percent recommended that their patients avoid the immunoglobin treatment, but when asked what they would do themselves, that number jumped to 62.9 percent. They attribute this, in part, to the idea of "betrayal aversion," i.e., the fear that something meant to prevent harm actually causes potentially even more harm itself. They suggest that when physicians make recommendations for others, they tend to focus on the decision that's easiest to defend, which is typically the option with the lowest mortality rate, regardless of the potential side effects.

The study's authors go on to conclude that just because physicians often make different decisions for themselves, it does not mean their personal decisions are necessarily better, given that the best choice in each scenario is debatable. They 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.