‘What would you do, Doc, if you were me?'

If you expect an honest answer to that question, think again. Doctors frequently make different choices for themselves than what they recommend to patients, suggests a study in today's issue of the Archives of Internal Medicine.

Researchers at Duke University in Durham, N.C., presented physicians with one of two scenarios, each with a choice of two treatments.

The first was between two surgical approaches to colon cancer. Both cured the cancer in 80 percent of patients, but one had a higher death rate with no adverse effects while the second had a lower death rate but caused side effects—including chronic diarrhea or colostomy (a surgically made opening for the bowel in the abdominal wall)—in 4 percent of patients. While nearly 40 percent of the doctors chose the treatment with the lower risk of side effects but higher risk of death for themselves, only about 25 percent recommended it for their patients.

The second scenario involved treatment for a hypothetical outbreak of the bird flu that kills 10 percent of infected people. Treatment could cut deaths in half—but itself cause death in 1 percent of patients and permanent paralysis in 4 percent. Nearly two-thirds of the doctors said in that case they would forgo treatment themselves, but only about half would make the same recommendation to their patients.

A total of 940 doctors responded to the surveys—242 for the colon-cancer scenario, and 698 for the bird-flu scenario.

Bottom line: It's hard to know why doctors seem to have different advice for patients than for themselves. Do they have different priorities than patients? Or do they just not take the time, or have the necessary introspection, to understand their patient's priorities?

In any case, I think the study supports my answer when a patient asks, "What would you do if you were me?" I say "I'm not you." Instead, I give them as much information about the risks and benefits that I can, help them put those statistics in perspective, and let them make the decision that's right for them, not for me.

See our tips on shared-decision making with your doctor.

Source
Study Finds Physicians Recommend Different Treatment Decisions For Patients Than They Choose For Themselves [Archives of Internal Medicine]

—Marvin M. Lipman, MD