Views and approaches toward risks and benefits among doctors who become patients.
OBJECTIVE
To understand how views and approaches concerning risks and benefits may be affected by dynamic contexts and processes related to clinical roles and relationships.


METHODS
We conducted two in-depth, semi-structured interviews with 50 doctors who became patients due to serious illnesses, concerning their experiences before and after diagnosis.


RESULTS
As patients, these doctors gained critical new insights into the processes and contexts of communication about risks and benefits. Doctors and patients often varied in how they viewed and weighed risks and benefits (e.g., as "good' or "bad"). These data suggest a model in which patients undergo several dynamic processes: seeking statistics, accepting doctors' framing of statistics, being influenced by media hype, seeing statistics as relevant or not, over-valuing risks, weighing the importance of risks and benefits, interpreting statistics as good or bad, accepting or denying statistics and odds, and making treatment decisions. These processes are affected by external factors (e.g., doctors ordering tests, framing statistics, and often over- versus under-valuing risks), and internal factors (e.g., depression, denial of illness, optimism versus pessimism, magical thinking--that doctors are immune to disease--and rationalizations).


CONCLUSIONS
Doctors and patients are engaged in complex, dynamic processes that shape patients' approaches toward risks and benefits.


CONCLUSIONS
These data highlight the need for increased attention toward these issues in medical educational and care.
Klitzman
Robert
R
Center for Bioethics, Columbia University, 1051 Riverside Drive, Unit 29, New York, NY 10032, USA. rlk2@columbia.edu
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003142:Communication; D003627:Data Interpretation, Statistical; D003657:Decision Making; D003717:Denial, Psychological; D004645:Empathy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D009341:Negativism; D009518:New York; D015404:Nursing Methodology Research; D010361:Patients / Q000523:psychology*; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011908:Rationalization; D018570:Risk Assessment; D012649:Self Concept; D011795:Surveys and Questionnaires