COLUMBUS, Ohio -- Doctors may be less likely to welcome input in medical decisions from patients who are near their own age, new research suggests.
In a study of medical students, residents and medical school faculty at Ohio State University and the University of Kansas, researchers found that the younger students and resident physicians advocated greater patient input from 75-year-olds than they did from 25-year-olds.
In contrast, the researchers found that the medical school faculty -- older, established physicians -- advocated greater patient input from 25-year-olds than they did from 75-year-olds.
"One explanation may be that each group recognizes its own inadequacies," said Robert A. Murden, an associate professor of internal medicine at Ohio State and a co-author of the study. "A second explanation may be that each group is most concerned about their age peers. Also, it could be that faculty realize that 75-year-olds have less desire to make decisions than do 25- year-olds
and based their responses on their past experiences with older and younger patients."
Murden conducted this research with Annalee Beisecker, associate professor of preventive medicine at the University of Kansas Medical Center; William P. Moore, a consultant with Olathe Corporation; Deborah Graham, director of clinical investigations at the Kansas Cancer Institute; and Linda Nelmig, a research assistant with the Kansas Cancer Institute. The group's work was published in a recent issue of the journal Medical Care.
For their study, Murden and his colleagues randomly divided 818 medical students, residents and faculty into two groups. One group read a vignette describing the medical condition of a hypothetical 25-year-old patient; the other group read the same vignette -- but was told it was a description of a 75-year-old patient.
After reading the vignette, the students and physicians were asked to respond to 13 medical care decisions with the vignette in mind. For each item, the researchers asked the respondents who should make the decision -- the doctor only, both doctor and patient, or the patient only. The 13 medical care decisions covered such areas as which drugs to use, whether to change medications, whether to consult another physician, how much to tell the patient's family and whether to stop treatment.
- Nine out of 10 respondents believed that physicians should have greater input in medical decisions than patients. However, for nine of the 13 medical decisions, more than 50 percent of respondents said that the doctor and the patient should make the decision together.
- For four medical decisions, more than 50 percent of respondents said the doctor should make the decision alone. These decisions covered what information should be included in the patient's medical history and various medication issues.
- In general, respondents advocated greater decision-making authority for older patients than for younger ones. "Ironically, it's younger patients who tend to want more of a say in medical decision making," Murden said. "In this study, the physicians were more willing to give autonomy to older patients than to younger ones. That seems to be backwards from what the patients want."
- Women medical students, residents and faculty members, however, were more supportive of patient input in medical decisions than their male counterparts. They also advocated slightly greater patient input for younger patients than for older ones. "This finding supports previous research demonstrating that female physicians are more nondirective and more attentive to interpersonal relationships with their patients," Murden said. "As more women are trained as physicians, we expect to see an increase in participatory decision making."
- The oldest respondents -- medical school faculty members -- were the least welcoming of patient input in medical decisions. "As training and experience increased beyond medical school, there was an increased tendency toward belief in physician-only decision making," Murden said. "It was a little distressing to see that faculty were the least interested in giving autonomy to patients."
Murden said he hopes people will use the findings from this study to better understand and improve their relationships with their own physicians.
"Along with patient age, physicians' gender and experience affect their willingness to grant patients the authority to participate in medical decisions," he said. "Younger patients might want more input than a physician is interested in giving -- especially if the physician is also young. From a practical standpoint, younger patients who want more input have to make their wishes known and take steps to achieve it."