patients

Doctors don't tell patients the truth about the treatments they'd use themselves

Tuesday, April 12, 2011 by: S. L. Baker, features writer
Tags: doctors, patients, health news

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(NaturalNews) Hopefully, this will never happen to you, but consider this scene: you've been diagnosed with a life threatening condition like colon cancer. So you sit down in your doctor's office to discuss your medical options with your physician and it turns out there are a couple of treatments.

"What would you do, doctor, if you were in my position?" would be a logical question to ask.

And, most likely, you'd expect an honest answer. The trouble is, you might very well not be told the truth.

In fact, according to a survey study published in the April 11 issue of Archives of Internal Medicine, what doctors consider the best choices in treatment for themselves is often not what they tell their patients is best for them.

Here's how Peter A. Ubel, M.D., of Duke University in Durham, North Carolina, and his colleagues came up with their findings. They surveyed two samples of U.S. primary care physicians. Each group of doctors was presented with one of two clinical treatment possibilities.

For the first scenario, 500 doctors were asked about what sort of treatment they'd recommend if they or one of their patients received a diagnosis of colon cancer. They were given two choices to pick from -- both were surgeries they could cure the colon malignancy in 80 percent of patients.

But there was a catch.

One operation had a higher death rate. However, it also had far fewer adverse side effects. On the other hand, the second type of surgery had a lower death rate but a small percentage of patients would be left with serious health problems including chronic diarrhea, intermittent bowel obstruction , a wound infection and/or the need for a colostomy (a surgical procedure that brings one end of the large intestine out through the abdominal wall where stools drain into a bag attached to the abdomen).

Almost half the doctors returned the colon cancer questionnaire and 37.8 percent of them stated that if they had received the cancer diagnosis, they would personally opt for the surgical procedure with a higher rate of death but a lower rate of the serious adverse effects listed above.

On the other hand, the majority of these doctors would have told their patients the operation with a lower death rate but a host of potentially very serious adverse effects was best for them.

The second hypothetical scenario polled 1,600 physicians about how they'd treat patients or themselves if faced with a new strain of avian flu infecting people in the U.S. One group of doctors was asked to imagine they had been infected; the other group was asked to imagine that a patient was infected with this serious influenza.

A single therapy was available for this strain of avian flu -- an immunoglobulin treatment. In people with the avian flu who weren't given immunoglobulin, there would be a 10 percent death rate and a 30 percent hospitalization rate with an average stay of a week. The treatment would reduce the rate of adverse events by half. However, in this scenario, the immunoglobulin therapy would also cause death in one percent of patients and permanent neurological paralysis in four percent of patients.

The avian influenza scenario survey was returned by 698 doctors and a whopping 62.9 percent of them said they'd personally refuse the immunoglobulin treatment when imagining they had been infected, in order to avoid its adverse effects.

But what decision did the docs make when imagining that a patient had been infected with the avian flu? The vast majority stated they'd recommend the immunoglobulin shots.

"Patients facing difficult decisions often ask physicians for recommendations," the authors stated as background information in the study. "However, little is known regarding the ways that physicians' decisions are influenced by the act of making a recommendation."

"In some circumstances, making recommendations could reduce the quality of medical decisions. In at least some circumstances, however, such as when emotions interfere with optimal decision making, this change in thinking could lead to more optimal decisions," the researchers concluded in their paper.

Curiously, Dr. Ubell and his research team think physicians probably different treatment recommendations for their patients than they would for themselves because of this: "...the very act of making a recommendation changes the way physicians weigh medical alternatives."

Another common sense alternative explanation could be that doctors are also considering legal ramifications --- for example, if they recommend a procedure with a slightly higher mortality rate and the patient dies, a family member might sue.

Whatever the explanation is, one thing is clear. This study is another example of why people should educate themselves about risks and possible benefits of medical treatments and take charge of their own health decisions whenever possible.

For more information:
http://archinte.ama-assn.org/

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