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Doctors Have Special Prescriptions

By John Salak


Come on, everyone kind of saw this coming. Doctors and their families are significantly less likely to ignore media general medical advice than all others. 

In fact, an MIT research team discovered that while the general population adheres to general medication guidelines almost 55 percent of the time, doctors and their families only follow these directives about 50 percent of the time. What gives? Well, the complexity of the guidelines probably isn’t the driver.

“There’s a lot of concern that people don’t understand guidelines, that they’re too complex to follow, that people don’t trust their doctors,” reported co-author Amy Finkelstein, a professor in MIT’s Department of Economics. “If that’s the case, you should see the most adherence when you look at patients who are physicians or their close relatives. We were struck to find that the opposite holds, that physicians and their close relatives are less likely to adhere to their own medication guidelines.”

Almost 6 million individual sets of administrative data, including almost 150,000 for doctors and close family members, were examined to discover this gap, which is somewhat counterintuitive. 

Those with higher incomes and access to special expertise, for example, generally deliver higher adherence levels, not lower ones like doctors and their families. Another curiosity is that no link was found between existing health status and adherence or even familiarity with the medications involved.

Ultimately, the discrepancy in adherence rates may result from doctors possessing “superior information about guidelines.” Consider prescribing antibiotics. Most guidelines recommend starting patients off with “narrow-spectrum” antibiotics, which are more targeted, rather than “broader-spectrum” antibiotics. 

Yes, broader-spectrum antibiotics may be more likely to eradicate an infection, but greater use of these antibiotics may also increase the chances that bacteria will develop resistance to these valuable medications, which can reduce efficacy for other patients. So, what may be good for the public in the long run—trying more targeted drugs first—may not work well for an individual patient.

Doctors know this and they could be more likely to prescribe broader-spectrum antibiotics for themselves and their families.

“You can imagine the reason doctors are less likely to follow the guidelines than other patients is because they know there’s this wedge between what’s good for them as a patient and what’s good for society,” Finkelstein theorized.

Doctors circumventing guidelines may also come into play when it comes to different types of prescription drugs that are typically avoided during pregnancies. In this case, doctors probably have a greater understanding of the trade-offs between the risks and rewards of prescribing so-called C-Class and D-Class drugs at this time.

“The results imply that probably what’s going on is that experts have a more nuanced understanding of what is the right course of action for themselves, and how that might be different than what the guidelines suggest,” added co-author Dr. Maria Polyakova.

None of these probably makes anyone feel any better or safe, of course, the doctors and their families, who appear to be playing an inside game when it comes to prescriptions. But what’s the answer? Stalking physicians to see how they treat themselves and their loved ones medically? 

Probably wouldn’t discover much and chances are the stalkers would wind up in jail or with a hypodermic need stuck in their butt. 

“Maybe it’s better for the guidelines to be transparent and say they recommend this not because it is [always] the best course of action for you, but because it is the best for society,” Polyakova suggests.

Oh, that’s sensible. Why didn’t someone think of that…

 

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