Docs choose riskier care for selves than patients

[April 12, 2011]  CHICAGO (AP) -- Physicians may choose riskier treatment for themselves than they'd recommend for their patients, according to a study that highlights a need for candid discussions about patients' preferences.

The findings are important because patients faced with difficult medical decisions often ask their doctors, "What would you do?" The answer reflects the doctors' values -- not necessarily those of the patient. Doctors should know what their patients value most before giving advice, and patients should ask doctors the reasons behind their answers, said study author Dr. Peter Ubel, an internist and behavioral scientist at Duke University.

For example, not all cancer patients would want life-prolonging treatment if it means suffering through horrible complications -- and their doctors should know that, Ubel said.

The study asked more than 700 primary-care doctors to choose between two treatment options for cancer and the flu -- one with a higher risk of death, one with a higher risk of serious, lasting complications.

In each of the two scenarios, doctors who said they'd choose the deadlier option for themselves outnumbered those who said they'd choose it for their patients.

That's likely because doctors are taught to do no harm, and death would be the ultimate harm. But also, some doctors likely reacted emotionally, recoiling at the notion of enduring "these kind of icky side effects," and they tended to put more faith in patients' ability to cope with lasting side effects, said Ubel.

He said previous research shows many people would react in a similar emotional way when presented with difficult choices for themselves versus others.

For example, one study asked participants if they would approach an attractive stranger in a bar if they noticed that person was looking at them. Many said no, but they would give a friend the opposite advice. Saying "no" meant avoiding short-term pain -- possible rejection by an attractive stranger -- but also missing out on possible long-term gain -- a relationship with that stranger.

The doctor study appears in Monday's Archives of Internal Medicine.

Two hypothetical situations were presented: one involved choosing between two types of colon cancer surgery; the less deadly option's risks included having to wear a colostomy bag and chronic diarrhea. The other situation involved choosing no treatment for the flu, or choosing a made-up treatment less deadly than the disease but which could cause permanent paralysis.

In the colon cancer scenario, about 38 percent of doctors chose the deadlier treatment for themselves, while 25 percent recommended that option for patients.

In the flu scenario, 63 percent chose the deadlier option of no treatment for themselves, versus 49 percent recommending it for patients.

Some advocates of giving patients a more active role in their care contend that doctors shouldn't make recommendations, but instead should neutrally present options, an Archives editorial notes.

But in tough situations, "it might not be fair to lay out the a la carte options and leave it to the patients" to decide, said editorial co-author Dr. Roshni Guerry.

But before making recommendations, doctors should discuss patients' personal, cultural and religious beliefs, and make sure that the doctors' own values don't get in the way, according to the editorial by Guerry and Drs. Eric Shaban and Timothy Quill, all from the University of Rochester Medical Center.

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Archives: http://www.archinternmed.com/

[Associated Press; By LINDSEY TANNER]

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