In one of my recent publications, I show that patient and physician risk preferences differ. Patients are willing to take take treatments with more both upside and downside risk, whereas physician prescribe treatments large based on which one provides the most efficacy to the average patient.
One question that remains is how do patients and physician preferences over treatments vary when both treatment efficacy and safety vary?
A paper by Ubel, Angott and Zikmund-Fisher (2011) have a novel approach to examining these tradeoffs. The authors ask physicians to select from two similar surgeries for colorectal cancer. The first surgery has better survival (i.e., lower death rate) but an increased chance of adverse events; the second surgery has worse survival prospects (higher death rate) but a reduced risk of adverse events. A similar scenario is provided for treatment of avian flu.
To examine differences in patient and physician preferences, the authors ask the physicians which treatment they would recommend for their patients, and which ones they would recommend for themselves if they were a patient. The study finds the following:
Among those asked to consider our colon cancer scenario (n=242), 37.8% chose the treatment with a higher death rate for themselves but only 24.5% recommended this treatment to a hypothetical patient (χ2=4.67, P=.03). Among those receiving our avian influenza scenario (n=698), 62.9% chose the outcome with the higher death rate for themselves but only 48.5% recommended this for patients (χ2=14.56, P<.001).
In short, when physicians prescribe treatment, they care more about efficacy and less about safety. When physicians are themselves patients, they have more concern for a treatment’s side effects.
- Ubel, Peter A., Andrea M. Angott, and Brian J. Zikmund-Fisher. “Physicians recommend different treatments for patients than they would choose for themselves.” Archives of Internal Medicine 171, no. 7 (2011): 630-634.