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


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


METHODS
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: χ(2) = 0.12, P = 0.73; schizophrenia scenario: χ(2) = 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.
Department of Psychiatry, Technische Universität München, München, Germany. r.mendel@lrz.tum.de
Rosmarie
R
Mendel
Johannes
J
Hamann
Eva
E
Traut-Mattausch
Markus
M
Bühner
Werner
W
Kissling
Dieter
D
Frey
D000328:Adult; D001291:Attitude of Health Personnel; D002755:Choice Behavior; D003376:Counseling; D003863:Depression / Q000628:therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D057240:Patient Preference / Q000523:psychology; D010817:Physician-Patient Relations / Q000941:ethics*; D011570:Psychiatry / Q000941:ethics*; D012381:Role Playing; D012559:Schizophrenia / Q000628:therapy; D057832:Watchful Waiting