One factor that shapes our medical decisions is simply the other’s opinions. We often consider what other people think when making our own medical decisions for at least two reasons.
How we use others’ opinions
One is that our medical decisions have consequences for others. We think about how her own medical choices will affect your partners, parents, children and friends. If a parent is temporarily incapacitated following surgery still need to rely on others for their children’s care. I won’t spend more time right now discussing how consequences for others affect our decisions.
That’s a topic that is a key part of the upcoming articles on altruism and social cooperation. Instead I want to explore a second reason: how we use others’ opinions to make medical decisions. The healthcare system in the United States and in many other countries relies on interactions between patients their physicians and other healthcare workers.
Complications are as bad as death
I’ll focus on how physicians influence patient decision-making because that’s what attracted the most research, but similar conclusions could be drawn for interactions with nurses, pharmacists and other caregivers. Let’s imagine a cancer scenario, and build a case study around this extreme medical situation.
There were two surgeries possible: an uncomplicated surgery that had a higher chance of death and the complicated surgery that had a lower chance of death but several vivid side effects and I told you that most people prefer the uncomplicated surgery even though they otherwise judge that its complications are as bad as death.
Less bias overall
Well, real researchers gave the same scenario to primary care physicians selected randomly from a large database. These are great physicians, the ones who take care of people on everyday basis. They are trained in objectively evaluating outcomes and understanding probabilities. On average they had almost 20 years of experience making medical decisions.
When the physicians were asked which treatment they would choose for themselves, a little less than 40% chosen the uncomplicated surgery. That’s less bias overall. The non-physicians who chose the uncomplicated surgery a bit more than 50% of the time, but still means however that almost half of those physicians chose the objectively worse outcome, despite their medical training and experience.
Physicians make objectively better decisions
But the physicians were also asked which treatment they would recommend for their patients. That changed many of those positions decisions. They became significantly less likely to recommend the uncomplicated surgery, doing so only 25% of the time, and more likely to pick the objectively better but complicated surgery.
Let me emphasize this important point: in this study physicians made objectively better decisions for their patients than for themselves. When recommending something to another person, especially somewhat unconnected to us, we try to think about their needs. We distance ourselves from the decision it doesn’t generate strong emotions.
Decisions that can be justified to others
Often our decisions focus on specific trade-offs that can be readily justified others. In this scenario, you can justify the complicate is surgery. Yes, there are a few potential complications but they are very rare and they’re still much better than death. This idea that advisors seek to make decisions that can be justified to others connects back to the concept of regret aversion introduced earlier.
Physicians want to avoid regret to and that can change what they recommend. One set of family practitioners were given the following sort of scenario: a patient comes in your office with chronic hip pain, they’ve tried a number of medications to help with her pain and none have worked.
Various approaches can be justified
You referred them to an orthopedic consultant so they can be evaluated for surgery. At the end of the visit you notice that there is one medication that they haven’t yet tried. Do you start them on that medication? About half the physician said yes. They prescribed that pain relief medication, about half said no, they wouldn’t start any new medication. That seems reasonable. Either answer can be justified.
Now a different group of family practitioners were given a modified version of the scenario. everything was the same but at the very end they were told that there were two medications that the patient had tried. The two medications were pretty similar: both were well known and widely used for pain management and one of them was the same medicine listed in the first scenario.
Medical decisions often rely on advice from others
So basically this group of physicians have the same decision as the first group but with one additional option, but now only 1/4 the physicians said that they prescribed either pain relief medication and the rest took the default option: referral with no new medications. Physicians exhibit the same biases as the rest of us.
Here the challenges that the two medications are very similar so it’s hard to choose between. There is more potential to make a decision that you later regret, like starting the patient on the wrong medication. That pushes their decisions toward not starting any medicine at all. In summary medical decisions often rely on advice from others particularly physicians and other healthcare workers.