Patient-physician discordance about benefits and risks in gastroenterology decision-making.
OBJECTIVE
To illustrate the characteristics of situations in gastroenterology when patients and physicians harbour different perspectives of medical costs and benefits, and how such different perspectives affect the outcome of medical decision-making.


METHODS
Two exemplary scenarios are presented, in which threshold analysis yields different results depending on the varying values assigned to identical medical events. The occurrence of varying values is subsequently phrased in economical terms of varying utility functions that characterize patient vs. physician behaviour.


RESULTS
Safety and therapy are the two major preferences that determine patient and physician utility functions. Patients and physicians make medical decisions based on two different utility functions. In comparison with their patients, gastroenterologists are more concerned with safety and inclined to spend more health care resources on safety than therapy because safety and the occurrence of medical complications affect their own professional status. In trying to maximize their own utility, gastroenterologists tend to spend more resources on safety than the patient him/herself might have spent given a free choice of management options.


CONCLUSIONS
In instances of potential complications associated with risky medical interventions, patients may receive less medical therapy in exchange for more procedural safety.
Sonnenberg
A
A
Portland VA Medical Center and Oregon Health and Science University, Portland, OR 97239, USA. sonnenbe@ohsu.edu
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D003657:Decision Making; D004106:Dilatation; D004940:Esophageal Stenosis / Q000628:therapy; D004943:Esophagogastric Junction; D005767:Gastrointestinal Diseases / Q000628:therapy*; D006801:Humans; D008100:Liver Abscess / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations
D000900:Anti-Bacterial Agents