DOCTORS’ DISCLOSURE OF BIAS: WHY GET A SECOND OPINION IF YOU DON’T KNOW WHAT TO DO WITH THE FIRST?
When you get advice from a doctor (or any other professional), you want to know if they have any potential biases. A potential financial conflict-of-interest might cause you to discount a doctor’s advice, even when offered in good faith based on professional expertise. In some instances, according to former physician and Cornell management professor Sunita Sah, there can even be an opposite effect: patients following a specialist’s advice more often when accompanied by a disclosure of bias than when not, a phenomenon Dr. Sah discusses in this Sunday opinion piece in the New York Times.
The thing that struck me most in the article was the differing effects between when doctors disclose a clear financial conflict of interest (“I get a referral fee whenever I put someone in a clinical trial”) versus a specialty bias (“I’m a surgeon so I am more likely to recommend surgery”). When doctors mention their referral-fee bias, patients become more skeptical and are less likely to follow a doctor’s recommendation. But when the doctor says, “I want you to know that I have this bias because I’m a surgeon and so I am more likely to recommend the surgical solution,” patients are three times more likely to select a surgical option than patients uninformed about this specialty bias.
I think that division is really interesting, given the blog I just wrote about how mental accounting causes us to treat “social currency” and “financial currency” in different and irrational ways. We see this in the difference between asking for a favor and offering to pay for the same favor. If money doesn’t enter the equation and I ask, “Could you do me a favor and pick me up while my car is in the shop?”, you’ll do it because it has value in the social market. But if I say, “Could you pick me up while my car’s in the shop? I’ll pay you $3,” you’ll be insulted, this despite the fact that $3 is more than $0. (It doesn’t help even if I bump up the offer to whatever Uber quotes for the same ride.) The difference is that in the first case you are accounting the act as a favor, so it is in the social ledger. In the second case, however, the offer of $3 moved the accounting into a financial exchange and putting a value of $3 on my time is insulting.
I feel like that might explain part of what’s happening with the doctors that Sah studied. When a doctor says, “I get money as a referral fee,” it becomes clear there is a financial conflict. The patient is now in the financial ledger. But disclosure of a specialty bias is removed from the issue of money. And if we move into the social ledger, we actually appreciate the doctor doing us the favor of going out of the way to caution us.
I’m not suggesting that a doctor’s specialty disables them from offering impartial advice. In fact, if you thought you needed surgery and got advice from everyone except a surgeon, you’d feel you were skipping an important part of your due diligence. The difference in your likelihood of following the specialist’s advice isn’t because of absence or presence of potential or actual bias. It’s about the degree to which you consider the interaction with the doctor social or financial.
The financial effect of the specialty bias is the same as when a doctor discloses a referral fee. If the surgeon admits a specialty bias, what’s unstated is “I make $________ every time you follow my recommendation and have surgery.” But we don’t think of it the same way because money is explicitly part of the referral-bias disclosure but not the specialty-bias disclosure. If doctors had to disclose their specialty bias by referring to money, I imagine patients would be much less likely to follow their specialty-related recommendations.