The Old Adage
Ever heard the expression, ”Do what I say, not what I do?” According to a new study published in the Archives of Internal Medicine what a doctor recommends for a patient may be different from what he recommends for himself.
Researchers looked at a group of primary care physicians and gave them one of two clinical scenarios. In the first scenario, they asked the doctors to imagine that either they or one of their patients was diagnosed with colon cancer and that they had two surgical options. Both procedures were equally likely to cure the cancer. But one had a higher death rate with fewer side effects and the other had a lower death rate with more side effects. 38% of the physicians would choose the surgery with the higher death rates and few side effects for themselves, whereas only 24% of the doctors would recommend the same for their patients.
In the second scenario, doctors were told that a new strain of the bird flu virus was found in the U.S. One group was told to imagine they themselves were infected with it. The other group was to imagine that one of their patients was infected. They then had to decide on whether to use one treatment, immunoglobulin. Without it, the death rate from the bird flu was 10%. With it, fewer people died but it could cause permanent paralysis in a small percentage of patients. Again in this case, a greater percentage of doctors would forego treatment for themselves but not necessarily recommend that for their patient.
What does this mean?
One theory is that when doctors make decisions about their own care, their own fears and emotions come into play. They may be saying, “I’m willing to accept a higher risk of death as long as I maintain my quality of life.” However, when it comes to patients, their own emotions don’t necessarily carry the same weight. Also, for many doctors, the ultimate goal is to prolong a patient’s life so they don’t think as much about the consequences of treatment as long as that objective is met.
So what should doctors and patients do?
Well, experts recommend that patients should ask their doctors, “What would you do in my situation? What if I were your brother or your mother?” That will encourage a physician to think long and hard about all the factors that may come into play when making a serious decision. They also encourage doctors to have more in depth discussions with patients to find out what their priorities or objectives are. Is it ultimately survival? Or is quality of life of paramount importance?
In My Experience
As a practicing physician, I often try to ask myself, “What would I do?” or “If he were my child, which choice would I make?” And I sometimes offer that information up to my patients or their parents. And even if they don’t make the same choices I would, at least I’ve given them the benefit of my knowledge and my honest opinion as though I were taking care of someone who meant the world to me.
Back to Headlines