Do surgeons treat their patients like they would treat themselves?

Science of Variation Group

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background There is substantial unexplained geographical and surgeon-to-surgeon variation in rates of surgery.Onewould 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 decisionmaking); and (4) assessing how dispassionate evidencebased decision aids help inform the patient and influences their decisional conflict.

Original languageEnglish (US)
Pages (from-to)3564-3572
Number of pages9
JournalClinical orthopaedics and related research
Volume473
Issue number11
DOIs
StatePublished - Nov 1 2015

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Patient Preference
Upper Extremity
Surgeons
Confidence Intervals
Therapeutics
Radius Fractures
Tendinopathy
Decision Support Techniques
Wounds and Injuries
Orthopedics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Science of Variation Group. / Do surgeons treat their patients like they would treat themselves?. In: Clinical orthopaedics and related research. 2015 ; Vol. 473, No. 11. pp. 3564-3572.
@article{ecbe02543cae48f4a04ce08213b83899,
title = "Do surgeons treat their patients like they would treat themselves?",
abstract = "Background There is substantial unexplained geographical and surgeon-to-surgeon variation in rates of surgery.Onewould 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 decisionmaking); and (4) assessing how dispassionate evidencebased decision aids help inform the patient and influences their decisional conflict.",
author = "{Science of Variation Group} and Janssen, {Stein J.} and Teun Teunis and Guitton, {Thierry G.} and David Ring and Spoor, {Andy B.} and Aakash Chauhan and Shafritz, {Adam B.} and Amy Wasterlain and Terrono, {Andrew L.} and Neviaser, {Andrew S.} and Andrew Schmidt and Andy Nelson and Miller, {Anna N.} and Anze Kristan and Thomas Apard and Arne Berner and Asif Ilyas and Axel Jubel and Bernhard Jost and George Babis and Barry Watkins and Barbara Kreis and Sears, {Benjamin W.} and Nolan, {Betsy M.} and Crist, {Brett D.} and Cross, {Brian J.} and Wills, {Brian P.D.} and Barreto, {Camilo Jose Romero} and Carl Ekholm and Carrie Swigart and Catherine Spath and Charalampos Zalavras and Charles Cassidy and Christos Garnavos and Colby Young and Moreno-Serrano, {Constanza L.} and Craig Rodner and Cyrus Klostermann and Osei, {Daniel A.} and Rikli, {Daniel A.} and Daniel Haverkamp and Daniel Polatsch and Darren Drosdowech and Edelstein, {David M.} and Denise Eygendaal and McKee, {Desirae M.} and {Van Deurzen}, Derek and Verbeek, {Diederik O.F.} and Michael Darowish and Randy Hauck",
year = "2015",
month = "11",
day = "1",
doi = "10.1007/s11999-015-4304-z",
language = "English (US)",
volume = "473",
pages = "3564--3572",
journal = "Clinical Orthopaedics and Related Research",
issn = "0009-921X",
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}

Do surgeons treat their patients like they would treat themselves? / Science of Variation Group.

In: Clinical orthopaedics and related research, Vol. 473, No. 11, 01.11.2015, p. 3564-3572.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Do surgeons treat their patients like they would treat themselves?

AU - Science of Variation Group

AU - Janssen, Stein J.

AU - Teunis, Teun

AU - Guitton, Thierry G.

AU - Ring, David

AU - Spoor, Andy B.

AU - Chauhan, Aakash

AU - Shafritz, Adam B.

AU - Wasterlain, Amy

AU - Terrono, Andrew L.

AU - Neviaser, Andrew S.

AU - Schmidt, Andrew

AU - Nelson, Andy

AU - Miller, Anna N.

AU - Kristan, Anze

AU - Apard, Thomas

AU - Berner, Arne

AU - Ilyas, Asif

AU - Jubel, Axel

AU - Jost, Bernhard

AU - Babis, George

AU - Watkins, Barry

AU - Kreis, Barbara

AU - Sears, Benjamin W.

AU - Nolan, Betsy M.

AU - Crist, Brett D.

AU - Cross, Brian J.

AU - Wills, Brian P.D.

AU - Barreto, Camilo Jose Romero

AU - Ekholm, Carl

AU - Swigart, Carrie

AU - Spath, Catherine

AU - Zalavras, Charalampos

AU - Cassidy, Charles

AU - Garnavos, Christos

AU - Young, Colby

AU - Moreno-Serrano, Constanza L.

AU - Rodner, Craig

AU - Klostermann, Cyrus

AU - Osei, Daniel A.

AU - Rikli, Daniel A.

AU - Haverkamp, Daniel

AU - Polatsch, Daniel

AU - Drosdowech, Darren

AU - Edelstein, David M.

AU - Eygendaal, Denise

AU - McKee, Desirae M.

AU - Van Deurzen, Derek

AU - Verbeek, Diederik O.F.

AU - Darowish, Michael

AU - Hauck, Randy

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Background There is substantial unexplained geographical and surgeon-to-surgeon variation in rates of surgery.Onewould 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 decisionmaking); and (4) assessing how dispassionate evidencebased decision aids help inform the patient and influences their decisional conflict.

AB - Background There is substantial unexplained geographical and surgeon-to-surgeon variation in rates of surgery.Onewould 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 decisionmaking); and (4) assessing how dispassionate evidencebased decision aids help inform the patient and influences their decisional conflict.

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