MADJAR

“Doctor, what would you do if it were you?” This question is often posed when patients feel most vulnerable — in times of extreme pain, after an ominous diagnosis, or near the end of life where the sky fills with dark clouds and hope is in short supply.

The question always gives me a pause, as I take inventory of its meaning. It reflects the patient’s deep understanding of their situation. They sense that an asymmetry exists between their knowledge and mine and attempt to bridge the gap by presenting a question designed to evoke empathy and deeper insight. What they are really asking is: Can you help me make this decision by putting yourself in my shoes — and by telling me more about what you know?

The question also indicates that the patient believes that the doctor may choose for themselves — or for their loved ones — a treatment that differs from what they recommend to their patients.

Is this suspicion justified? When faced with a difficult medical decision, do doctors choose differently than what they suggest to others?

This kind of knowledge gap–and the accompanying skepticism — isn’t unique to medicine. Similar dynamics could exist when dealing with plumbers, matchmakers, investment advisors, realtors, and anyone who is in the business of giving advice. If you were me, would you repair the water heater, or replace it? Would you marry John, or George? Would you sell my house now, or wait for a better offer?

About real estate agents, we have some real data: In an article published by the National Bureau of Economic Research in January 2005, Steven D. Levitt and Chad Syverson wrote about the informational advantage of real estate agents and its impact on home sales. The researchers found that “homes owned by real estate agents sell for about 3.7 percent more than other houses and stay on the market about 9.5 days longer…” In other words, while realtors recommend to their clients to sell their home earlier and at a lower price, they wait longer and secure higher prices for their own homes. They don’t follow the advice they give.

I wanted to believe that medicine was different — that doctors would adhere to the same guidance they give their patients. After all, medical decisions are not just economic — they involve life, death, pain, and suffering. Surely, the advice that doctors offer — rooted in rigorous training, scientific research, and professional ethics — would be balanced, objective, and consistent, both for patients and for themselves. Or so I thought.

In reality, however, doctors don’t always follow the advice they give to their patients. The most dramatic illustration of this phenomenon comes to the forefront when doctors face their own impending death. Yes, doctors grow old and die too, but when the time comes to decide how to navigate the end of life, they often choose differently from what they recommend to others.

In a 2013 article published in Missouri Medicine, Dr. Ken Murray, a Clinical Assistant Professor of Family Medicine at the University of South California, wrote about end-of-life decision making in the medical profession. The article titled “Getting Comfortable With Death & Near-Death Experiences: How Doctors Die: A Model for Everyone?” vividly describes what he observed over the years: “Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone.” … “They want to be sure, when the time comes, that no heroic measures will happen – that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).”

Is Dr. Murray right? Is his claim–that doctors administer so much care that they wouldn’t want for themselves — backed by scientific evidence? How do doctors die differently? And how can you receive the care your doctors would choose for themselves by asking the right questions? I will tell you more in my next article.