Wednesday, April 13, 2011

WHAT WOULD YOU DO IF IT WERE YOU, DOC?

A group from Duke University and the University of Michigan wondered whether a choice in treatment that physicians would make for themselves might differ from what they'd recommend to a patient. How do researchers dream up such ideas, anyway? Well, when they looked, sure enough, there was a dramatic difference. You can find the abstract at  http://archinte.ama-assn.org/cgi/content/abstract/171/7/630.

The researchers presented physicians with two hypothetical treatment alternatives. One choice carried a higher likelihood of dying, but a higher quality of life if they didn't die. I call this the "quality" choice. Choice number two--I'll call it "quantity"--involved a greater chance of survival but with troubling aftereffects. The docs were asked to recommend one of the two treatments for a patient, and also one for themselves if they were the patient.

38% of the docs chose "quality" for themselves but only 25% recommended it to their patients. In a scenario with another hypothetical illness, 63% chose "quality" for themselves but only 49% chose that for their patients. In other words, the docs would usually advise patients to opt for probable quantity over quality of life while they'd choose the opposite for themselves.

What sense are we to make of this double standard? Maybe physicians assume that patients want survival at all costs. But they really can't know what patients want unless they ask. One of the authors, Dr. Peter Ubel, concluded from this study that patients shouldn't request advice until their doctor understands them better, including how they weigh issues such as quality versus length of life. Said Dr. Ubel, "I think the doctors, when they were imagining themselves as the patients, were saying, 'Yes, there is a higher survival, but I don't want to put up with these horrible side effects.' On the other hand, when they are making recommendations for the patients, it is easier to push those emotions aside.''

Medical doctors have traditionally been taught, implicitly but thoroughly, to push their emotions aside. But here's a situation where that skill--if you want to call it that, and not a disability--can actually degrade treatment. After all, obtaining medical care isn't the same as, say, obtaining a pair of socks. The relationship between seller and buyer of socks is inconsequential, but the patient-doctor link is fraught with life and death issues. If healthcare is to be conducted as though people matter, it must necessarily honor the emotions of all parties.

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