Double Standard for Doctors?

Doctors' Recommendations for Patients Often Different Than for Themselves, Study Finds

April 11, 2011 -- When facing a difficult medical decision, patients often ask their doctors what to do.

What the doctor recommends for a patient is likely to be different from what a doctor would decide for himself or herself, according to a new study. It sheds light on what may seem like doctors' double standards.

"The way the doctor weighs the risk and benefits of your alternatives could change dramatically depending on whether the doctor is thinking about what he or she would do or thinking about what you ought to do," says Peter A. Ubel, MD, a professor of business, public policy and medicine at Duke University, Durham.

''The bottom line of the study is, those tradeoffs feel different if you are the decision maker vs. the advice giver," Ubel tells WebMD.

The study is published in the Archives of Internal Medicine.

Little is known about what influences doctors' treatment recommendations, Ubel says.

To find out more, he and his colleagues surveyed two different groups of U.S. primary care doctors.They presented each with one of two scenarios.

The first scenario asked the doctors to imagine if they or one of their patients had gotten a diagnosis of colon cancer. They had two surgical options to treat it. Both procedures cured the colon cancer 80% of the time.

However, one had a higher death rate, 20%, and fewer adverse side effects. The other option had a lower death rate, 16%, but had side effects. The side effects included chronic diarrhea and having to have a colostomy. In this procedure, the end of the colon (large intestine) is brought through an opening in the abdominal wall, where the stool exits.

In all, 242 doctors returned the questionnaire. When they had the cancer diagnosis, nearly 38% chose the option with a higher death rate but fewer side effects. When they were making the recommendation for a patient, only 24.5% chose the same option.

In the second survey, doctors imagined a new strain of bird flu had arrived in the U.S. One group was told to imagine they were infected. Another group imagined a patient was.

They had to decide on one treatment, immunoglobulin. Without it, 10% of patients die and 30% are hospitalized for about a week. The treatment was known to reduce the rate of side effects by half. However, the treatment led to 5% of patients dying from the flu, 1% dying from the treatment, and 4% contracting permanent paralysis.

Of the 698 doctors who responded, nearly 63% said they would not get the treatment themselves, to avoid the adverse effects. But only 48.5% would tell their patients not to get it.

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