The role of physicians' recommendations in medical treatment decisions

Background. A shift away from the medical paternalism of the past has occurred, and today, the law and ethics advocate that physicians share decision-making responsibility with their patients. It is unclear, however, what the appropriate role of physicians' recommendations ought to be in this new shared decision-making paradigm. One way to approach this question is to assess the influence of physicians' recommendations. Objective. In this study, the authors examine the influence of physicians' recommendations on hypothetical treatment decisions. Do physicians' recommendations on hypothetical treatment decisions in scenarios where the decision that maximizes health is obvious and apparent to subjects? Do recommendations Pull subjects away from the treatment choice that they otherwise prefer (based on their decision when unaware of the physicians' recommendation)? Design. An experimental web questionnaire presented hypothetical medical treatment scenarios in which the treatment choice that maximized health was obvious. Across scenarios, the authors varied physicians' recommendations in 3 ways: (1) physicians' recommendations supporting what maximized health, (2) physicians' recommendations that went against what maximized health, and (3) no physicians' recommendation. The participants were 102 volunteers. Results. Hypothetical treatment decisions were significantly influenced by physicians' recommendations (P < 0.0001), and physicians' recommendations against the decision that maximized health pulled Subjects away from the treatment decision that they made when no recommendation was given (P < 0.0001). Conclusion. Physicians' recommendations can lead people to make decisions that go against what is best and against what they would otherwise prefer. Physicians must take care in making recommendations and should incorporate patient preferences into their recommendations.