When should patients not follow the advice of their doctors?

Question — When should patients not follow the advice of their doctors?

Answer — Most of the time.

Or, at least, that’s what the recent study published in the Archives of Internal Medicine seems to have found. As Dr Timothy Quill, author of an accompanying editorial in the journal, says:

It’s a pretty clear message: There’s a discrepancy between what doctors recommend to their patients and to themselves.

As the researchers say in their background to the study — Patients facing difficult decisions often ask physicians for recommendations. However, little is known regarding the ways that physicians’ decisions are influenced by the act of making a recommendation.

They presented physicians with two different clinical scenarios: colon cancer and avian flu. Both scenarios involved two treatment alternatives, one of which had a better chance of survival with more side effects and the other with a lower chance of survival but less side effects:

  • For the colon cancer scenario, “37.8% chose the treatment with a higher death rate for themselves but only 24.5% recommended this treatment to a hypothetical patient”.
  • In the avian flu scenario — “62.9% chose the outcome with the higher death rate for themselves but only 48.5% recommended this for patients”.

What accounts for the difference? Are doctors being duplicitous? Believe that patients can “take” more side effects?

Would love to hear your thoughts!

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Comments
4 Responses to “When should patients not follow the advice of their doctors?”
  1. Dial Doctors says:

    It’s not about whether patients can ‘take’ more side effects. It’s our jobs as doctors to basically get the patient have a longer life with as much quality of life as possible. We must assess whether or not a procedure, even when life threatning, will provide a better chance for the patient. But when it comes to us it’s different. This is one of those times where knowledge can do more harm. As doctors we know that sometimes we can do everything and beyond the call of duty and the patient still dies. It comes with the job. When recommending a treatment plan for a patient I always go for the one that can guarantee a longer life but if it comes to me? I’d rather have 2 simple months than 2 grueling years. Patients want us to keep fighting for them so we do but most doctors, myself included, are happy with a better present

  2. Ed Kim says:

    At issue here is the fact that often physicians don’t take patient preference, values, and sophistication into consideration when giving recommendations. They are, therefore, providing very generic, un-customized advice to patients while taking their own individual circumstances, values, and preferences into consideration when weighing their own choices.

    Shared decision-making starts with true informed consent – I’m not sure how completely we as physicians inform our patients, esp. given diminishing reimbursement for non-procedural activities. The ongoing dialogue that shapes a consensus decision on treatment plans is not something that payers seem to care about. This is probably short-changing the entire system and economically inefficient, since better decision-making will likely yield better outcomes.

  3. Michael Wong says:

    Ed makes a great point. How many physicians actually know their patients? For example, for a patient who has just been diagnosed with hypertension, there are a lot of treatment options out there. However, if the patient is an athlete, perhaps diuretic and beta-blocker would not be prescribed. Instead, many would consider an ACE inhibitor or angiotensin-II-receptor blocker. It’s easier just to tell patients what they should take. As Ed says, it’s harder, more time consuming, and even less profitable to engage in a dialogue. However, it’s not just doctors, perhaps the whole health industry is guilty of this (what do you think?) — http://wp.me/p1fYJ7-92

  4. Michael Wong says:

    Dr Itzhak Brook writes a fascinating account of his own experiences as a neck cancer patient, “A Physician’s Experience as a Cancer of the Neck Patient: The Importance of Patient Participation”

    As Dr Brook writes, “I am telling my personal story in the hope that health care providers will realize the difficult challenges faced by a patient diagnosed with cancer and undergoing extensive surgeries. I am also discussing the importance of active participation of the patient and their family members in all phases of care.”

    http://www.jopm.org/perspective/narratives/2011/04/18/a-physician’s-experience-as-a-cancer-of-the-neck-patient-the-importance-of-patient-participation/

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