Study: Doctors Are Less Likely to Follow Medical Guidelines

According to research, doctors and their families are less likely to follow medical guidelines. Why is medical advice harder to take for medical professionals?

Key takeaways:

It's a common gripe of doctors that patients don't do what they're told. A recent study, however, found that doctors are even worse at following their own guidelines than their patients.

Swedish scientists and Stanford fellows at the Institute for Economic Policy Research (SIEPR) found that doctors are less likely to follow medical guidelines than their patients.

The study, published in the medical journal American Economic Review, noted that doctors and their close relatives follow medical guidelines just over 50 percent of the time. In comparison, the average patient follows a doctor's instructions 54% of the time.

With already low compliance to medical guidelines, the researchers were very surprised by their findings.

“Doctors are the most informed patients. If medical recommendations are too complex, for example, or the patient-provider relationship is bad, this shouldn’t affect doctors themselves, so we would expect them to adhere at much higher rates. Instead, we find the opposite,” said co-author of the study, Petra Persson, the Swedish economist and Assistant Professor in Economics at Stanford University.

The researchers used millions of data points to reach their discovery. They looked at Swedish administrative data from 2005 to 2016 and how it related to 63 guidelines for prescription drugs.

In total, nearly 6 million people who fit at least one of the medication guidelines took part in the study. Of that group, about 150,000 were doctors or close relatives of doctors. By looking at how well prescription drug decisions fit these patients' medical situations, the researchers were able to learn more about what rules people followed.

The researchers then tried to find out why doctors follow fewer guidelines. They were able to rule out a few important hypotheses.

Though this is typically true in society at-large, when focusing on medical professionals, failure to follow medical guidelines has nothing to do with socioeconomic status.

“Access to doctors is associated with lower adherence despite, rather than because of, the high socioeconomic status,” said the researchers in the paper.

A patient's health doesn’t affect how well they follow medical guidelines.

A greater understanding of specific medications doesn’t necessarily affect a person’s desire to follow medical guidelines.

Co-author and health economist Maria Polyakova noted a shift in health care, from a “one-size-fits-all approach" toward a “precision medicine” model. With the newer model, treatments are more likely to be customized to each patient.

Polyakova said that because of this change, doctors and medical experts may choose to tailor treatment decisions for themselves more than they do with most patients.

"We find that patients who have access to medical expertise are, on average, less likely to follow medication guidelines," says the research paper.

Previous studies show that there may be negative effects for patients when doctors stray from medical guidelines for patients.

“Guidelines serve as a baseline,” Persson said. “If poor communities are not getting the same level of care as everyone else, that’s a reason to want to ensure that there is a universal minimum standard of care.”

The researchers say that more information is needed to figure out if doctors who don't follow medical guidelines are good or bad for the health of their patients as a whole.

As noted in the paper, “An important avenue for further research is to identify whether and when non-adherence is in the patient’s best interest.”

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