# Should Golden Rule apply to Docs?



## Ernest Nagel (Apr 13, 2011)

Would you prefer that they do unto you as they do to themselves? Do you think Doctors have any professional obligation to explain all your treatment options and the associated risks or does that just create confusion and stress?

http://www.bbc.co.uk/news/health-13036508

*Doctors 'often defy' their own treatment advice*
By Michelle Roberts Health reporter, BBC News
Doctors may choose a different treatment if they were the patient

Many doctors recommend treatments to their patients that they would not use themselves, a US study suggests.

Experts asked nearly 1,000 US physicians to consider a medical scenario and pick a treatment.

But when doctors were asked to imagine themselves as the patient their answers differed significantly.

Doctors were far more likely to opt for a therapy carrying a higher chance of death but better odds of side-effect free survival, for example.

But for their patients, doctors tended to pick a treatment that erred on the side of survival, regardless of the quality of life, Archives of Internal Medicine reports.
Death risk

Faced with a choice of one of two operations to treat bowel cancer, for example, two-fifths of 242 physicians chose the surgical procedure with a higher rate of death, but a lower rate of adverse effects.

Conversely, when asked to make a recommendation for a patient, only a quarter of physicians chose this option.
Continue reading the main story
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Our study does not suggest that physicians always make better decisions for others than they would make for themselves

The research authors

In another scenario, doctors were asked to imagine that either themselves or a patient was infected with a new case of bird flu.

They were told a drug treatment was available, and that without this treatment a person who contracted flu would have a 10% risk of death and 30% risk of needing hospital care.

Treatment would halve the rate of adverse events but also caused death in 1% of patients and permanent neurological paralysis in 4%.

Of nearly 700 doctors, about two-thirds chose to forgo the treatment when imagining they had been infected, to avoid its adverse effects.

However, when imagining that a patient had been infected, only half recommended not taking the treatment.

Dr Peter Ubel, from Duke University, North Carolina, and colleagues say: "When physicians make treatment recommendations, they think differently than when making decisions for themselves."

What is not clear is which is the best way to reach a treatment decision - putting yourself in the shoes of another or not.

Indeed, today doctors are often discouraged from giving their own personal opinion and instead are encouraged to present the relevant evidence and information so that the patient can make the choice for themselves.

"Our study does not suggest that physicians always make better decisions for others than they would make for themselves.

"At most, our study suggests that in some circumstances, the act of making a recommendation might improve decision making," say the researchers.
'Reliant on doctors'

Katherine Murphy, chief executive of UK-based The Patients Association, said it was "very telling" that the research had found many doctors may take a different course of action from the one they would advise their patients to follow.

"Doctors are of course human and will weigh up the options subjectively for themselves, no matter what they recommend to their patients.

"The difference is that doctors will have all the medical knowledge to back up their decision whereas patients are sometimes entirely reliant on their doctor for information.

"If the government is serious about making patient choice a reality, it must ensure that all patients have access to meaningful information in a variety of formats on all treatment options so they can come to a decision which is right for them."


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## penguin (Apr 13, 2011)

I want my doctor to recommend the treatment right for me and my condition, and to suggest alternatives if I'm not sure I like the first. AFAIK, we don't have the same pressure from the drug companies here that the US does, and I have a good relationship with my doctor, so I'm confident she'll suggest the right course of action.


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## Dr. Feelgood (Apr 13, 2011)

I don't know if the British are as fond of suing one another as we Yankees are, but I suspect the difference in the doctors' responses was due, at least in part, to self-preservation. Doctors are probably richer than most of their patients (and perhaps perceived as being even richer than they are), and any doctor who loses a patient runs the risk of being sued for malpractice by the patient's relatives. Malpractice insurance is extremely expensive, and getting sued will not lower one's rates, so I am not surprised if doctors recommend to their patients whatever treatment is least likely to result in fatality.


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## Ernest Nagel (Apr 14, 2011)

Dr. Feelgood said:


> I don't know if the British are as fond of suing one another as we Yankees are, but I suspect the difference in the doctors' responses was due, at least in part, to self-preservation. Doctors are probably richer than most of their patients (and perhaps perceived as being even richer than they are), and any doctor who loses a patient runs the risk of being sued for malpractice by the patient's relatives. Malpractice insurance is extremely expensive, and getting sued will not lower one's rates, so I am not surprised if doctors recommend to their patients whatever treatment is least likely to result in fatality.



Dr F, Texas passed limited liabilty law for physician's several years ago and the concensus is health care quality has gone up. Physician's are definitely moving here in droves so clearly malpractice exposure is a concern that must figure in the care they provide. I don't want someone thinking about what their treatment would look like in court if I have to become a corpse to exonerate them.


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## Webmaster (Apr 14, 2011)

Ernest Nagel said:


> Would you prefer that they do unto you as they do to themselves? Do you think Doctors have any professional obligation to explain all your treatment options and the associated risks or does that just create confusion and stress?



I am very jaded when it comes to all this. 

I find it absurd that a magazine ad or TV commercial now must be accompanied by endless fine print while, stunningly, the label on most medications doesn't even say what it is supposed to be for.

I find it ridiculous that it's become practically impossible to get a straight opinion from a doctor because they are so afraid to be sued. 

I think our medical system is essentially bankrupt due to a combination of extreme costs and extreme fear of being sued. 

In the best of all worlds, and one that I don't even think is so unreasonable to expect, I'd simply want for my doctor to tell me what I suffer from, what they can do about it, what not, and what the chances for recuperation are. Nothing more and nothing less. 

As is, I very much agree that doctors probably often have a very different private opinion from the official one they pass on to their patients.


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## GTAFA (Apr 14, 2011)

Actually this makes sense. When I am talking to my Mom about her health, or making plans for my grandchild, I am more cautious with their lives than my own. Doctors smoke & drink even though they don't normally counsel us to take up tobacco or alcohol.


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