Clin Orthop Relat Res. 2015 May 9. [Epub ahead of print]

Do Surgeons Treat Their Patients Like They Would Treat Themselves?


Science of Variation Group:
Andy B. Spoor; Aakash Chauhan; Adam B. Shafritz; Amy Wasterlain; Andrew L. Terrono; Andrew S. Neviaser; Andrew Schmidt; Andy Nelson; Anna N. Miller; Anze Kristan; Thomas Apard; Arne Berner; Asif Ilyas; Axel Jubel; Bernhard Jost; George Babis; Barry Watkins; Barbara Kreis; Benjamin W. Sears; Betsy M. Nolan; Brett D. Crist; Brian J. Cross; Brian P. D. Wills; Camilo Jose Romero Barreto; Carl Ekholm; Carrie Swigart; Catherine Spath; Charalampos Zalavras; Charles Cassidy; Christos Garnavos; Colby Young; Constanza L. Moreno-Serrano; Craig Rodner; Cyrus Klostermann; Daniel A. Osei; Daniel A. Rikli; Daniel Haverkamp; Daniel Polatsch; Darren Drosdowech; David M. Edelstein; Denise Eygendaal; Desirae M. McKee; Derek van Deurzen; Diederik O. F. Verbeek; Minoo Patel; Drago Brilej; Erik T. Walbeehm; Emilija Stojkovska Pemovska; Eric Hofmeister; Eric L. L. Twiss; Eric Mark Hammerberg; Evan D. Schumer; F. Thomas D. Kaplan; Fabio Suarez; Carlos H. Fernandes; Francisco Lopez-Gonzalez; Frank L. Walter; Franz Josef Seibert; Frede Frihagen; Gerald Kraan; Guillaume Gadbled; Georg M. Huemer; Georges Kohut; Giuseppe Porcellini; Grant Garrigues; Grant J. Bayne; Gregory DeSilva; H. Brent Bamberger; H. W. Grunwald; Hans Goost; Henry Broekhuyse; Holger Durchholz; Howard D. Routman; Izaa¨k F. Kodde; Iain McGraw; Ian Harris; Ines C. Lin; Jack Choueka; Jack Elias Kazanjian; James A. Gillespie; Jan Biert; Jeffrey A. Greenberg; Jeffrey Abrams; Jeffrey Wint; Jennifer L. Giuffre; Jennifer Moriatis Wolf; Joachim P. Overbeck; Job N. Doornberg; Johan H Scheer; John Itamura; John M. Erickson; John McAuliffe; John T. Capo; John Taras; Jonathan Braman; Jorge Rubio; Jose Eduardo Grandi Ribeiro Filho; Joseph Abboud; Joseph M. Conflitti; Joshua M. Abzug; Juan M. Patin˜o; Juan Miguel Rodriguez Roiz; Julie Adams; Julius Bishop; Karoush Kabir; Karol Zyto; Kendrick Lee; Kevin Eng; Kevin M. Rumball; Konul Erol; Kyle Dickson; Kyle Jeray; Chris Bainbridge; Lodewijk Poelhekke; Paul van Minnen; Ladislav Mica; Lars C. Borris; Lars E. Adolfsson; Lawrence Weiss; Leah M. Schulte; Lewis B. Lane; Lior Paz; Lisa Taitsman; Lob Guenter; Louis Catalano; Luiz Aaugusto B. Campinhos; Luke S. Austin; Panagiotis Lygdas; Mohammad Waseem; M. Jason Palmer; Matthijs R. Krijnen; Mahmoud I. Abdel-Ghany; Marc Swiontkowski; Marco Rizzo; Marijke Oidtmann; Marinis Pirpiris; Mariusz Bonczar; Mark I. Loebenberg; Martin Boyer; Martin Richardson; Matt Mormino; Matthew Menon; Maurizio Calcagni; Maxime Beaumont-Courteau; Maximillian Soong; Megan M. Wood; Sven A. Meylaerts; Michael Darowish; Michael Nancollas; Michael Prayson; Michael Quinn; Michael W. Grafe; Michael W. Kessler; Michel P. J. van den Bekerom; Michell Ruiz-Suarez; Miguel A. Pirela-Cruz; Mike Mckee; Milind Merchant; Minos Tyllianakis; Mohamed Shafi; Naquira Escobar Luis Felipe; Nata Parnes; Neal C. Chen; Neil Wilson; Nelson Elias; Ngozi M. Akabudike; Nicholas J. Horangic; Nicholas L. Shortt; Niels Schep; Nigel Rossiter; Nikolaos K. Kanakaris; Ole Brink; Percy V. van Eerten; Paolo Paladini; Parag Melvanki; Parag Sancheti; Peter Althausen; Peter Giannoudis; Peter Hahn; Peter J. Evans; Peter Jebson; Peter Kloen; Peter Krause; Peter R. G. Brink; Peter Schandelmaier; Anil Peters; Phani Dantuluri; Philip Blazar; Philipp Muhl; Platz Andreas; Pradeep Choudhari; Prashanth Inna; Prosper Benhaim; Quell; R. Glenn Gaston; Robert Haverlag; Radzeli Mohd Ramli; Ralph M. Costanzo; Ramon de Bedout; Ashish Ranade; Randy Hauck; Raymond Malcolm Smith; Reto H. Babst; Richard Jenkinson; Richard L. Hutchison; Richard S. Gilbert; Richard S. Page; Richard Wallensten; Rick Papandrea; Robert D. Zura; Robert R. Slater Jr; Robert R. L. Gray; Robert Wagenmakers; Rodrigo Pesantez; Roger G. Hackney; Roger van Riet; Ryan P. Calfee; Samir Mehta; Samy Bouaicha; Sander Spruijt; Sanjeev Kakar; Saul Kaplan; Scott F. Duncan; Scott G. Kaar; Scott Mitchell; Sergio Rowinski; Svenhjalmar van Helden; Sidney M. Jacoby; Stephen A. Kennedy; Stephen K. Westly; Steven Beldner; Steven J. Morgan; George Sulkers; Tim Schepers; Taco Gosens; Taizoon Baxamusa; Theodoros Tosounidis; Theresa Wyrick; Thierry Begue; Thomas DeCoster; Thomas Dienstknecht; Thomas F. Varecka; Thomas Higgins; Thomas J. Fischer; Thomas Mittlmeier; Thomas Wright; Tim Chesser; Timothy Omara; Todd Siff; Tomo Havlifc¸ek; Valentin Neuhaus; Vani J. Sabesan; Vasileios S. Nikolaou; Michael Verhofstad; Vincenzo Giordano; Vishwanath M. Iyer; Anne Vochteloo; W. Arnnold Batson; Warren C. Hammert; William Dias Belangero; Wojciech Satora; Yoram Weil; Zsolt Balogh

Abstract

BACKGROUND:

There is substantial unexplained geographical and surgeon-to-surgeon variation in rates of surgery. One would expect surgeons to treat patients and themselves similarly based on best evidence and accounting for patient preferences.

QUESTIONS/PURPOSES:



(1) Are surgeons more likely to recommend surgery when choosing for a patient than for themselves? (2) Are surgeons less confident in deciding for patients than for themselves?

METHODS:



Two hundred fifty-four (32%) of 790 Science of Variation Group (SOVG) members reviewed 21 fictional upper extremity cases (eg, distal radius fracture, De Quervain tendinopathy) for which surgery is optional answering two questions: (1) What treatment would you choose/recommend: operative or nonoperative? (2) On a scale from 0 to 10, how confident are you about this decision? Confidence is the degree that one believes that his or her decision is the right one (ie, most appropriate). Participants were orthopaedic, trauma, and plastic surgeons, all with an interest in treating upper extremity conditions. Half of the participants were randomized to choose for themselves if they had this injury or illness. The other half was randomized to make treatment recommendations for a patient of their age and gender. For the choice of operative or nonoperative, the overall recommendation for treatment was expressed as a surgery score per surgeon by dividing the number of cases they would operate on by the total number of cases (n = 21), where 100% is when every surgeon recommended surgery for every case. For confidence, we calculated the mean confidence for all 21 cases per surgeon; overall score ranges from 0 to 10 with a higher score indicating more confidence in the decision for treatment.

RESULTS:



Surgeons were more likely to recommend surgery for a patient (44.2% ± 14.0%) than they were to choose surgery for themselves (38.5% ± 15.4%) with a mean difference of 6% (95% confidence interval [CI], 2.1%-9.4%; p = 0.002). Surgeons were more confident in deciding for themselves than they were for a patient of similar age and gender (self: 7.9 ± 1.0, patient: 7.5 ± 1.2, mean difference: 0.35 [CI, 0.075-0.62], p = 0.012).

CONCLUSIONS:



Surgeons are slightly more likely to recommend surgery for a patient than they are to choose surgery for themselves and they choose for themselves with a little more confidence. Different perspectives, preferences, circumstantial information, and cognitive biases might explain the observed differences. This emphasizes the importance of (1) understanding patients' preferences and their considerations for treatment; (2) being aware that surgeons and patients might weigh various factors differently; (3) giving patients more autonomy by letting them balance risks and benefits themselves (ie, shared decision-making); and (4) assessing how dispassionate evidence-based decision aids help inform the patient and influences their decisional conflict.

LEVEL OF EVIDENCE:



Level III, diagnostic study.


http://www.ncbi.nlm.nih.gov/pubmed/25957212