Doctors defy their own advice, shows study

12 April 2011 Last updated at 00:43 GMT 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 shows.

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.

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

End Quote 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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Tebbit 'move to find jobs' advice

22 February 2011 Last updated at 06:38 GMT Lord Tebbit met students from Merthyr Tydfil College who made a film about welfare reform An ex-minister who once advised the jobless to get on their bikes says Merthyr Tydfil's unemployed should consider moving to find work.

Lord Tebbit was being interviewed by Merthyr Tydfil College students who made a film about the potential effects of the UK government's welfare reform.

The former Conservative party chairman said people in the UK should follow the example of those in Poland and Hungary.

The UK government says its reforms will encourage the jobless back to work.

When asked whether people in Merthyr should get on their bikes and look for work, Lord Tebbit replied: "Yes people do have to get up and go.

"People do it in Poland, people do it in Hungary, people do it in Lithuania. Why are they more willing to do it than we are?"

In 1981, when more than 3m people were unemployed, Lord Tebbit, then Margaret Thatcher's secretary of state for employment, famously caused controversy when he told the jobless to get on their bikes to find work.

The students' encounter with him is shown on BBC Wales' Week In Week Out programme on Tuesday.

Merthyr currently has the second highest percentage of people seeking jobs in Wales, and regularly features in surveys of areas with the highest rates of people claiming incapacity benefit.

The once thriving industrial town has also been hit by job cuts in manufacturing, including the loss of production at the Hoover factory in 2008.

Student Gemma Griffiths, 23, and her sister Donna, 21, who grew up in a family on benefits in Merthyr, made the 15-minute film shown to Lord Tebbit.

The Griffiths sisters say they were raised in a family hit by poverty

Last week the UK coalition government unveiled plans to reform the welfare system and promised to make work worthwhile.

Prime Minister David Cameron promised "to make work pay for some of the poorest people in our society".

A "universal credit", sanctions for those turning down jobs, and a cap on benefits paid to a single family were among the changes outlined.

But Gemma Griffiths said: "I made this film because I grew up in a family in poverty and I think the benefit reform is a bad idea because it will push Merthyr into deeper poverty than it already is."

The sisters spoke to a number of benefit claimants who face losing out because of changes to the rules, and they both believe cutting benefits in the current economic climate will make poor people in Merthyr poorer.

But Lord Tebbit told them: "It is an interesting film which shows up some very longstanding deep-rooted problems.

"When I was a kid at school we'd all had fathers who had been unemployed but I don't think any of us had a father who had never been employed.

"Why have we got today fathers who have never worked? In that sense we are worse off than we were before the war, before the welfare state.

"I think some people may get less well off, may get poorer.

"But the question is whether we can help the majority of people to get out of that hole."

Last year, Work and Pensions Secretary Iain Duncan Smith sparked debate when he said people in Merthyr had become "static" and suggested they "get on a bus" to find work in Cardiff.

Week In Week Out, Message from Merthyr, is on BBC One Wales at 2235 GMT on Tuesday, 22 February.

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