Doctors as patients comply with guidelines only about 50% of the time, whereas among the average patient, the adherence to the guidelines was nearly 55% indicating a 3.8 percentage point lower adherence rate, according to a study published in the journal American Economic Review.¹

A team of researchers from MIT, Stanford University and Harvard University examined data of Swedish individuals, aged 85 or younger, from 2005 through 2016 to evaluate the differences in adherence of patients to 63 government-issued guidelines for prescription drugs with personal access to medical expertise to those without access. If the patient, or their partner or parents or children were doctors, this was considered as having access to medical expertise. A doctor in the extended family was also regarded as access to medical expertise.

Out of the 5,887,471 individuals examined, who came under the purview of at least one guideline, 149,399 were doctors or their close family members; more than 95% of them had access to expertise all through the duration of the study. Six of the guidelines were pertaining to the use of antibiotics, 20 guidelines were about medication use by the elderly, 20 were about medication for specific conditions, while 17 were related to the use of prescription drugs during pregnancy. The guidelines were further subclassified as “don’t take” or “do take” guidelines. The authors further note that “adherence to “do take” guidelines requires the compliance of both the provider (to prescribe the medication) and the patient (to fill the prescription). Adherence to “don’t take” guidelines requires the compliance of either the provider (not to prescribe the medication) or the patient (not to fill the prescription).”

Results showed that when participants had access to expertise, the adherence to guidelines was generally less. Among non-expert patients who were themselves not doctors or had a family member (close or extended) who was a doctor, the adherence to guidelines was 54.4%. However, among doctors and their families, the adherence was just 50.6%. The difference was most discernible for antibiotics. Access to expertise was associated with 5.2% less acquiescence to the guidelines with regard to appropriate use of antibiotics.

After controlling for demographics, income and education, out of the 63 guidelines assessed, doctors and their families followed the recommendations infrequently in 41 instances. This difference was statistically significant in 20 cases. Doctors and their families acted in accordance with the guidelines in 22 cases; the difference was statistically significant in only 3 cases.

The researchers also attempted to find likely reasons for the low adherence to guidelines among doctors and their families as patients. They ruled out socioeconomic status as not applicable to doctors/health professionals. The poor adherence was greater for guidelines with less robust evidence supporting the recommendations. Since they are conversant with the intricacies and nuances, doctors would know what is right for them. The authors also note that “another possible explanation for the adherence gap is that access to expertise is associated with greater familiarity and comfort with pharmaceutical solutions to medical problems, or greater ease of filling prescriptions, and thus a greater propensity to take medications even in contradiction of guidelines”.

It is said that generally doctors are not the best of patients. The findings of this study seem to give credence to this commonly held assumption. Charity begins at home. Doctors should take care of their health not only for themselves but also for their patients. Furthermore, they are role models for society. They are the most well-informed; hence, have a responsibility of practicing what they teach their patients and lead by example.

Reference

1. Finkelstein A, et al. A taste of their own medicine: guideline adherence and access to expertise. Am Econ Rev. 2022;4(4):507-26.