You’re given a prescription for a drug. The illegible handwriting of the doctor tells you to take one pill 43 times a day with mules. You correctly interpret the instructions to mean that you take it three times a day when you eat—but do you?
None of us is great at following prescription guidelines; in fact, just 54.4 percent of us take a pharmaceutical as instructed. But there’s a class of citizens that is even more rebellious. The sceptic, perhaps? Or your typical WDDTY subscriber? Nope, it’s the doctor (and his family).
Doctors are the least likely to follow their own guidelines and take the drug as recommended by the manufacturer. Just 50.6 percent do so, which came as a bit of a surprise to a group of economists from the Massachusetts Institute of Technology when they examined the records of 5.88 million Swedes, which included nearly 150,000 doctors, to see adherence levels for 63 prescription medications. 1
“There’s a lot of concern that people don’t understand guidelines, that they’re too complex to follow, or that people don’t trust doctors,” said lead researcher Amy Finkelstein. If that’s the case, you’d expect doctors to be the exception and follow their own instructions, she pondered. But no. “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.”
But why aren’t doctors taking their own medicine properly? The MIT researchers considered—and rejected—several possibilities. For one, it’s true that people from low socioeconomic groups are less likely to follow the guidelines, but doctors are loaded so that won’t wash.
Then there’s the possibility that doctors are taking more prescription drugs than their patients, possibly because they know just how good the medication is, but that isn’t true either. Doctors don’t excessively self-medicate—in fact, it’s more likely they are taking fewer drugs than their patients.
No, they aren’t following the guidelines because they have “superior information”, the researchers conclude. Doctors know just how dangerous and inappropriate a medication can be, and so they lower the dose themselves, but don’t pass on their “superior information” to their patients.
Immediate family members of the doctor are also lowering the dose, so at least they are beneficiaries of the superior information.
And this superior information is especially handy when it comes to a few drugs in particular. Antibiotics are a case in point: doctors are told to prescribe narrow spectrum antibiotics that target an infection, but which aren’t as effective as a broad-spectrum variety. But if doctors gave all their patients broad spectrum antibiotics, resistance would increase, and the day of the superbug would draw ever nearer.
So they don’t—but they still prescribe them for themselves and their family. “There’s a wedge between what’s good for them as a patient and what’s good for society,” Prof Finkelstein explained, clearly missing the fact that doctors are being selfish.
It cuts both ways. Doctors are also more likely to prescribe C-class drugs for pregnant family members than they would for patients. “Experts (ie, doctors) 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,” explained Maria Polyakova, another MIT researcher. In other words, doctors know the drugs can help during pregnancy—which is why they confidently prescribe them to family members—but don’t think the general public should be given them.
Despite explaining the actions of doctors, the economists were still left with a sense of unease or ‘unresolved tensions,’ as they put it. Doctors could be more honest with patients, especially when it came to prescribing an antibiotic. “Maybe it’s better for the guidelines to be transparent and say they recommend this not because it is the best course of action for you (the patient), but because it is the best for society,” opined Prof Polyakova. The doctor could also mention that, nonetheless, he’s taking the broad-spectrum variety, and screw society.
Antibiotics aside, perhaps the doctors have a point. Are we taking too many drugs too often, and are current guidelines in the best interests of the patient? Doctors clearly are worried, but in saying nothing, is this more hypocrisy than Hippocrates?
