Is great information good enough? Evidence from physicians as patients

Mortality of working-age physicians compared to other high-skilled occupations in Austria from 1998 to 2020

OBJECTIVES

Physicians have been shown to have lower mortality compared to the general population, particularly regarding lifestyle-associated causes of death. Prior literature is divided on whether this is due to higher socioeconomic position (SEP), healthier lifestyle, or other specific occupational characteristics. This study analyzed the mortality of Austrian physicians compared to the general population and other (health) professionals with a similar SEP, and investigated patterns of lifestyle-associated mortality among physicians.

METHODS

Data from professional associations and cause-of-death statistics were collated to determine causes of death for all occupational groups. Gender-specific age-standardized mortality rates (ASMR) and standardized rate ratios (SRR) were calculated to compare main causes of death [cancer, cardiovascular disease (CVD), external causes] among physicians to other (health) professionals and the general population. Standardized mortality ratios (SMR) were calculated for more detailed causes of death in physicians compared to the general population.

RESULTS

Physicians had lower all-cause mortality than the general population [SRR 0.45, 95% confidence interval (CI) 0.41-0.49 for males and SRR 0.60, 95% CI 0.54-0.66 for females] and health professionals (SRR 0.72, 95% CI 0.60-0.88 for males and SRR 0.77, 95% CI 0.63-0.93 for females), mostly due to low CVD and cancer mortality. SMR for detailed causes of death among physicians exhibited a pattern of particularly low mortality in lifestyle-associated causes of death and an increased SMR for suicide among female physicians (SMR 1.58, 95% CI 1.22-2.02).

CONCLUSIONS

This study confirmed lower mortality among physicians compared to the general population and compared to other (health) professionals. Low physician mortality can be primarily explained by lifestyle-associated causes of death.

Understanding the disconnect between lifestyle advice and patient engagement: a discourse analysis of how expert knowledge is constructed by patients with CHD

OBJECTIVE

Adherence to healthy lifestyle advice is effective in prevention of non-communicable diseases like coronary heart disease (CHD). Yet patient disengagement is the norm. We take a novel discursive approach to explore patients' negotiation of lifestyle advice and behaviour change.

METHOD

A discourse analysis was performed on 35 longitudinal interviews with 22 heterosexual British people in a long-term relationship, where one had a diagnosis of CHD. The analysis examined the relationships between patients' constructions of expert knowledge and the implications of these accounts for patients' dis/engagement with lifestyle advice.

RESULTS

Expert knowledge was constructed in four ways: (1) Expert advice was valued, but adherence created new risks that undermined it; (2) expert knowledge was problematised as multiple, contradictory, and contested and therefore difficult to follow; (3) expert advice was problematised as too generalised to meet patients' specific needs; and (4) expert advice was understood as limited and only one form of valued knowledge.

CONCLUSION

Patients and partners simultaneously valued and problematised expert knowledge, drawing on elaborate lay epistemologies relating to their illness which produced complex patterns of (dis)engagement with expert lifestyle advice. Recognition of the multiple and fluid forms of knowledge mobilised by CHD patients could inform more effective interventions.

How power shapes behavior: Evidence from physicians

Power-the asymmetric control of valued resources-affects most human interactions. Although power is challenging to study with real-world data, a distinctive dataset allowed us to do so within the critical context of doctor-patient relationships. Using 1.5 million quasi-random assignments in US military emergency departments, we examined how power differentials between doctor and patient (measured by using differences in military ranks) affect physician behavior. Our findings indicate that power confers nontrivial advantages: "High-power" patients (who outrank their physician) receive more resources and have better outcomes than equivalently ranked "low-power" patients. Patient promotions even increase physician effort. Furthermore, low-power patients suffer if their physician concurrently cares for a high-power patient. Doctor-patient concordance on race and sex also matters. Overall, power-driven variation in behavior can harm the most vulnerable populations in health care settings.

Patient and peer: Guideline design and expert response

We examine how patients' medical expertise influences adherence to clinical guidelines for a treatment that is common, costly, and rationed by the clinical guidelines. Using administrative data on prenatal diagnostic testing (PDT), we compare the testing rates of medically trained patients (experts) and non-medically trained patients (non-experts) on the margin of eligibility thresholds in clinical guidelines. We find that experts are 9 percentage points more likely to receive PDT than non-experts when they are not eligible for testing and that more than 80% of the difference can be attributed to medical expertise. Our results suggest that the design of clinical guidelines is important for adherence and that having medical expertise as a patient affects treatment, when there is room for a deviation from the guideline.

Care Experiences and Visit Use of Physician and Nonphysician Medicare Patients

This cross-sectional study compares care experiences and outpatient visit use between physician-patients and nonphysician-patients.

Behavioral Economics Interventions to Improve Medical Decision-Making

BACKGROUND

In medicine, a wide gap exists between the medical care that ought to be possible in the light of the current state of medical research and the care that is actually provided. Behavioral biases and noise are two major reasons for this.

METHODS

We present the findings of a selective literature review and illustrate how interventions based on behavioral economics can help physicians make better decisions and thereby improve treatment outcomes.

RESULTS

A number of behavioral economics interventions, making use of, for example, default settings, active decision rules, social norms, and self-commitments, may improve physicians' clinical decision-making. Evidence on long-term effects is, however, mostly lacking.

CONCLUSION

Despite their apparent potential, the application of behavioral economic interventions to improve medical decisionmaking is still in its infancy, particularly in Germany.

Online and offline health information seeking and the demand for physician services

We examine the relationship between Internet-based health information seeking and the demand for physician services, using data collected from the 28 European Union states in 2014. Unlike previous research, our analysis distinguishes seekers of health information into those who use only non-Internet sources and those who use the Internet and possibly non-Internet sources. By comparing the frequencies of physician visits among the two groups of health information seekers and non-seekers, we infer the net association between online health information and the demand for physician services while partially controlling for the effects of concurrent seeking of offline health information. The following are the two key findings: (1) individuals' health status and sociodemographic factors shape online and offline health information seeking patterns in similar ways; and (2) the demand for physician services is positively associated with offline health information seeking and not with online health information. The net association with online health information would be even smaller after controlling for the effect of concurrent offline health information seeking. These results suggest that extending the availability of online health information would potentially reinforce the unequal access to health information, which could create greater variation in individuals' health management skills and benefits from health care in the long term. However, it would be associated with little or no increase in the demand for physician services, unlike the implications of previous research.