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‘What would you do if you were me, doctor?’: randomised trial of psychiatrists' personal v. professional perspectives on treatment recommendations

  • Rosmarie Mendel (a1), Johannes Hamann (a1), Eva Traut-Mattausch (a2), Markus Bühner (a2), Werner Kissling (a1) and Dieter Frey (a3)...
Abstract
Background

If patients are unsure whether a specific treatment is really good for them, they often pose the question, ‘What would you do if you were me, doctor?’ Patients want their psychiatrists to put themselves in their shoes and not to give a ‘standard recommendation’.

Aims

To study whether this question really leads psychiatrists to reveal their personal preferences.

Method

Randomised experimental study with 515 psychiatrists incorporating two decision scenarios (depression scenario: antidepressant v. watchful waiting; schizophrenia scenario: depot v. oral antipsychotic) and three experimental conditions (giving a recommendation to a patient asking, ‘What would you do if you were me, doctor?’; giving a regular recommendation to a patient without being asked this question; and imagining being ill and deciding for yourself). Main outcome measures were the treatments chosen or recommended by physicians.

Results

Psychiatrists choosing treatment for themselves predominantly selected other treatments (mostly watchful waiting and oral antipsychotics respectively) than what psychiatrists recommended to patients when asked in the ‘regular recommendation role’ (i.e. antidepressant and depot respectively). Psychiatrists in the ‘what-would-you-do role’ gave recommendations similar to the ‘regular recommendation role’ (depression scenario: χ2 = 0.12, P = 0.73; schizophrenia scenario: χ2 = 2.60, P = 0.11) but distinctly different from the ‘self role’.

Conclusions

The question ‘What would you do if you were me, doctor?’ does not motivate psychiatrists to leave their professional recommendation role and to take a more personal perspective. Psychiatrists should try to find out why individuals are asking this question and, together with the individual, identify the most appropriate treatment option.

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Corresponding author
Rosmarie Mendel, Department of Psychiatry, Technische Universität München, Möhlstraße 26, 81675 München, Germany. Email: r.mendel@lrz.tum.de
Footnotes
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See editorial, pp. 429–430, this issue.

Declaration of interest

R.M. has received honoraria from Janssen-Cilag. J.H. has received honoraria and/or research supports from Boehringer, Eli Lilly, Janssen-Cilag, Sanofi-Aventis, Astra Zeneca and Bristol-Myers Squibb. W.K. has received honoraria and/or research supports from Janssen-Cilag, Sanofi-Aventis, Johnson & Johnson, Pfizer, Bristol-Myers Squibb, AstraZeneca, Lundbeck, Novartis and Eli Lilly.

Footnotes
References
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1 Baylis, F, Downie, J. Professional recommendations: disclosing facts and values. J Med Ethics 2001; 27: 20–4.
2 Zaner, R. Physicians and patients in relation – clinical interpretation and dialogues of trust. In Handbook of Bioethics – Taking Stock of the Field from a Philosophical Perspective (ed Khushf, G): 223–50. Kluwer Academic Publishers, 2004.
3 Hayes, DF. What would you do if this were your … wife, sister, mother, self? J Clin Oncol 1991; 9: 13.
4 Gardner, M, Ogden, J. Do GPs practice what they preach? A questionnaire study of GPs' treatments for themselves and their patients. Patient Educ Couns 2005; 56: 112–5.
5 Steinert, T. Which neuroleptic would psychiatrists take for themselves or their relatives? Eur Psychiatry 2003; 18: 40–1.
6 Belanger, D, Moore, M, Tannock, I. How American oncologists treat breast cancer: an assessment of the influence of clinical trials. J Clin Oncol 1991; 9: 716.
7 Domenighetti, G, Casabianca, A, Gutzwiller, F, Martinoli, S. Revisiting the most informed consumer of surgical services. The physician-patient. Int J Technol Assess Health Care 1993; 9: 505–13.
8 Amering, M, Denk, E, Griengl, H, Sibitz, I, Stastny, P. Psychiatric wills of mental health professionals: a survey of opinions regarding advance directives in psychiatry. Soc Psychiatry Psychiatr Epidemiol 1999; 34: 30–4.
9 Moncrieff, J, Kirsch, I. Efficacy of antidepressants in adults. BMJ 2005; 331: 155–7.
10 Raymark, PH. Accepting or rejecting medical treatment: a comparison of decisions made for self versus those made for a significant other. J Applied Soc Psychology 2000; 30: 2409–36.
11 Zikmund-Fisher, BJ, Sarr, B, Fagerlin, A, Ubel, PA. A matter of perspective: choosing for others differs from choosing for yourself in making treatment decisions. J Gen Intern Med 2006; 21: 618–22.
12 Jonas, E, Schulz-Hardt, S, Frey, D. Giving advice or making decisions in someone else's place: the influence of impression, defense, and accuracy motivation on the search for new information. Pers Soc Psychol Bull 2005; 31: 977–90.
13 Kray, L, Gonzalez, R. Differential weighting in choice versus advice: I'll do this, you do that. J Behav Decis Making 1999; 12: 207–17.
14 Kray, LJ. Contingent weighting in self-other decision making. Organ Behav Hum Decis Process 2000; 83: 82106.
15 Belcher, VN, Fried, TR, Agostini, JV, Tinetti, ME. Views of older adults on patient participation in medication-related decision making. J Gen Intern Med 2006; 21: 298303.
16 Festinger, L. A Theory of Cognitive Dissonance. Stanford University Press, 1957.
17 Frey, D. Recent research on selective exposure to information. In Advances in Experimental Social Psychology, Vol 19 (ed Berkowitz, L): 4180. Academic Press, 1986.
18 Heimer, CA. Responsibility in health care: spanning the boundary between law and medicine. Wake Forest Law Rev 2006; 41: 465507.
19 Sharpe, VA. Behind closed doors: accountability and responsibility in patient care. J Med Philos 2000; 25: 2847.
20 Spiegelberg, H. Steppingstones toward an Ethics for Fellow Existers. Essays 1944–1983. Martinus Nijhoff Publishers, 1986.
21 Ubel, PA. “What should I do, doc?”: some psychologic benefits of physician recommendations. Arch Intern Med 2002; 162: 977–80.
22 Quill, TE, Brody, H. Physician recommendations and patient autonomy: finding a balance between physician power and patient choice. Ann Intern Med 1996; 125: 763–9.
23 Jones, TV, Gerrity, MS, Earp, J. Written case simulations: do they predict physicians' behavior? J Clin Epidemiol 1990; 43: 805–15.
24 Podsakoff, PM, MacKenzie, SB, Lee, JY, Podsakoff, NP. Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol 2003; 88: 879903.
25 Jonas, E, Frey, D. Information search and presentation in advisor-client interaction. Organ Behav Hum Decis Process 2003; 91: 154–68.
26 Chambers, R, Belcher, J. Self-reported health care over the past 10 years: a survey of general practitioners. Br J Gen Pract 1992; 42: 153–6.
27 Tyssen, R. Health problems and the use of health services among physicians: a review article with particular emphasis on Norwegian studies. Ind Health 2007; 45: 599610.
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‘What would you do if you were me, doctor?’: randomised trial of psychiatrists' personal v. professional perspectives on treatment recommendations

  • Rosmarie Mendel (a1), Johannes Hamann (a1), Eva Traut-Mattausch (a2), Markus Bühner (a2), Werner Kissling (a1) and Dieter Frey (a3)...
Submit a response

eLetters

Psychiatrist as an actor and as an observer: Is there an attribution error ?

Raman D Pattanayak, Senior Research Associate (CSIR)
08 December 2010

The article (1) on personal versus professional perspectives of psychiatrists was genuinely interesting. It focuses on a very simple, yet basic issue and forces us to introspect. Its findings and their discussionhave left an impression enough to be recalled each time we come across this familiar question ‘What would you do if you were me, doctor?’.

While the discussion was particularly engaging, an important possibility was not considered among the possible explanations for discrepant personal and professional perspective on treatment recommendations. It is that of a ‘fundamental attribution error’ (2,3) or ‘correspondence bias’ (4), which is a theory rooted primarily in social psychology, but even psychiatrists despite their training and expertise may not be totally immune to its existence. They may attribute the few depressive symptoms listed in patient vignette to a biologically rooted depressive illness, however there may be a self-serving bias or actor-observer bias at work in self-role scenario with attribution directed at various possible situational causes, more of a 'reactive' form of depresion. It could explain watchful waiting in self versus start of anti-depressant in patient. Similarly, the line ‘sometimes forgets to take the necessary antipsychotics…’ in Schizophrenia case vignette may be attributed to a disposition of patient (and therefore, more frequent prescription of depot anti-psychotics) and could be attributed to situational causes in self .

It would be interesting to further test the role of these attributional errors in similar experimental situations involving professionals. Existing research also points out that the fundamental attribution errors are more common in people from Individualistic culturesin contrast to those from collectivistic cultures e.g India. Of even more interest would be to see if there are any cross-cultural differences in perspectives of the psychiatrists. Another possible area of investigation is if these findings are unique to psychiatrists or generally true for allphysicians and have implications for self-diagnosis and self-treatment by the ill physician. We stop here, but not before noting that the theme of the article is not only interesting, but perhaps getting a bit inspiring too!

References:

1.Mendel R, Hamann J, Traut-Mattausch E, Bühner M, Kissling W, FreyD. ‘What would you do if you were me, doctor?’: Randomized trial of psychiatrists’ personal v. professional perspectives on treatment recommendations. The British Journal of Psychiatry 2010 197: 441-447

2.Ross, L. The intuitive psychologist and his shortcomings: Distortions in the attribution process. In: L. Berkowitz (Ed.), Advances in experimental social psychology, 1997, pp. 173–220 , New York: Academic Press

3.Jones, E.E. & Harris, V.A. The attribution of attitudes. J ExpSoc Psychol 1967; 3: 1–24

4.Gilbert, D.T., & Malone, P.S. The correspondence bias. PsycholBull 1995; 117: 21–38

5.Morris, M.W., & Peng, K. (1994). Culture and cause: American and Chinese attributions for social and physical events. J Pers Soc Psychol; 67: 949-971
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Conflict of interest: None Declared

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