Neurosurgical decision making: personal and professional preferences

Restricted access

OBJECT

Physicians are often solicited by patients or colleagues for clinical recommendations they would make for themselves if faced by a clinical situation. The act of making a recommendation can alter the clinical course being taken. The authors sought to understand this dynamic across different neurosurgical scenarios by examining how neurosurgeons value the procedures that they offer.

METHODS

The authors conducted an online survey using the Congress of Neurological Surgeons listserv in May 2013. Respondents were randomized to answer either as the surgeon or as the patient. Questions encompassed an array of distinct neurosurgical scenarios. Data on practice parameters and experience levels were also collected.

RESULTS

Of the 534 survey responses, 279 responded as the “neurosurgeon” and 255 as the “patient.” For both vestibular schwannoma and arteriovenous malformation management, more respondents chose resection for their patient but radiosurgery for themselves (p = 0.002 and p = 0.001, respectively). Aneurysm coiling was chosen more often than clipping, but those whose practice was ≥ 30% open cerebrovascular neurosurgery were less likely to choose coiling. Overall, neurosurgeons who focus predominantly on tumors were more aggressive in managing the glioma, vestibular schwannoma, arteriovenous malformation, and trauma. Neurosurgeons more than 10 years out of residency were less likely to recommend surgery for management of spinal pain, aneurysm, arteriovenous malformation, and trauma scenarios.

CONCLUSIONS

In the majority of cases, altering the role of the surgeon did not change the decision to pursue treatment. In certain clinical scenarios, however, neurosurgeons chose treatment options for themselves that were different from what they would have chosen for (or recommended to) their patients. For the management of vestibular schwannomas, arteriovenous malformations, intracranial aneurysms, and hypertensive hemorrhages, responses favored less invasive interventions when the surgeon was the patient. These findings are likely a result of cognitive biases, previous training, experience, areas of expertise, and personal values.

ABBREVIATIONSACoA = anterior communicating artery; AVM = arteriovenous malformation; IVH = intraventricular hemorrhage; PGY = postgraduate year; PT1–5 = 1–5 years posttraining; PT5–10 = 5–10 years posttraining; PT>10 = more than 10 years posttraining.

Article Information

Correspondence Omar Tanweer, Department of Neurosurgery, New York University, 462 First Ave., Ste. 7S4, New York, NY 10016. email: omar.tanweer@nyumc.org.

INCLUDE WHEN CITING Published online January 9, 2015; DOI: 10.3171/2014.11.JNS14400.

DISCLOSURE The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

References

  • 1

    Aberegg SKHaponik EFTerry PB: Omission bias and decision making in pulmonary and critical care medicine. Chest 128:149715052005

  • 2

    Asch DABaron JHershey JCKunreuther HMeszaros JRitov I: Omission bias and pertussis vaccination. Med Decis Making 14:1181231994

  • 3

    Bornstein BHEmler AC: Rationality in medical decision making: a review of the literature on doctors' decision-making biases. J Eval Clin Pract 7:971072001

  • 4

    Chen JYTse EYLam TPLi DKChao DVKwan CW: Doctors' personal health care choices: a cross-sectional survey in a mixed public/private setting. BMC Public Health 8:1832008

  • 5

    Clarke JO'Sullivan YMaguire N: A study of self-care among Irish doctors. Ir Med J 91:1751761998

  • 6

    Emanuel EJEmanuel LL: Four models of the physician-patient relationship. JAMA 267:222122261992

  • 7

    Ghaffarzadegan NEpstein AJMartin EG: Practice variation, bias, and experiential learning in cesarean delivery: a data-based system dynamics approach. Health Serv Res 48:7137342013

  • 8

    Kahneman DTversky A: Prospect theory: an analysis of decision under risk. Econometrica 47:2632921979

  • 9

    Koehler JJGershoff AD: Betrayal aversion: when agents of protection become agents of harm. Organ Behav Hum Decis Process 90:2442612003

  • 10

    Minkoff HLyerly AD: “Doctor, what would you do?”. Obstet Gynecol 113:113711392009

  • 11

    Molyneux AJKerr RSYu LMClarke MSneade MYarnold JA: International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:8098172005

  • 12

    Quill TEBrody H: Physician recommendations and patient autonomy: finding a balance between physician power and patient choice. Ann Intern Med 125:7637691996

  • 13

    Raymark PH: Accepting or rejecting medical treatment: a comparison of decisions made for self versus those made for a significant other. J Appl Soc Psychol 30:240924362000

  • 14

    Ubel PAAngott AMZikmund-Fisher BJ: Physicians recommend different treatments for patients than they would choose for themselves. Arch Intern Med 171:6306342011

  • 15

    Wachtel TJWilcox VLMoulton AWTammaro DStein MD: Physicians' utilization of health care. J Gen Intern Med 10:2612651995

  • 16

    Zikmund-Fisher BJSarr BFagerlin AUbel PA: A matter of perspective: choosing for others differs from choosing for yourself in making treatment decisions. J Gen Intern Med 21:6186222006

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 6 6 6
Full Text Views 280 280 21
PDF Downloads 121 121 9
EPUB Downloads 0 0 0

PubMed

Google Scholar