Risk is in the eye of the beholder: Doctors must assist patients in decision making
What would you decide if you were faced with this decision?
Your doctor tells you that you have a virus. There is no cure. You are told you have a 10 percent chance of dying from the virus. However, there is an effective vaccine, made from a weakened form of the virus. But the vaccine has an unfortunate side effect: there is a 5 percent chance that you will die from the less serious form of the flu the vaccine can cause.
Would you take the vaccine? Would you give it to your child? If you were a doctor, would you tell a patient to get the shot? If you were the head of a large hospital, would you recommend the vaccine for all patients?
If you apply statistical risk analysis, the answer to this hypothetical problem is quite clear: a person is much better off taking the vaccine. But people do not always arrive at health decisions by applying mathematical models.
The Journal of General Internal Medicine has a new study reported in the June issue. Researchers found that the person's answer depended on which role the person was asked to assume. There was no logical reason to recommend the vaccine in some situations but not in others. The risk is the same for everyone.
The data suggests that the more distant the decision maker was from the patient, the more likely people were to recommend the vaccine.
- 48 % said they would take the vaccine, themselves;
- 57 % said they would decide to give it to their children;
- 63 % said that if they were the doctor, they would give it to their patients; and
- 73 % said as medical director of a hospital they would recommend the vaccine for all patients.
Dr. Donald A. Redelmeier, a professor of medicine at the University of Toronto who was not involved in the study, said, "What's intriguing is that these people are sometimes unaware of the extent to which their opinions can be changed by the way the question is posed."
In real life situations, patients and their families often face much more confusing choices than the fictional problem in Dr. Ubel's study. However, according to Dr. Paul Appelbaum, a professor of psychiatry at Columbia, doctors may be going too far in their zeal to present only the facts. "Physicians who place emphasis on informed consent have mistakenly come to see this as a process in which they play only a neutral role," Dr. Appelbaum said, "and not the role of someone who gives advice as well. Yet patients who value the information often value the advice, too, and that seems to me a very proper role for a physician to play."