There is substantial, unexplained geographical and surgeon-to-surgeon variation in rates of surgery. One would expect surgeons to treat patients and themselves similarly based on best evidence and accounting for what matters most to the patient before them (their values). However, one study found that surgeons are slightly more likely to recommend surgery for a patient than they are to choose surgery for themselves, and they choose for themselves with a little more confidence (1). Different perspectives, preferences, circumstantial information, and cognitive biases might explain the observed differences. This emphasizes the importance of understanding a patient’s values, preferences and circumstances; being aware that surgeons and patients might weigh various factors differently; giving patients more autonomy by letting them balance risks and benefits themselves (ie, shared decision-making); and assessing how dispassionate, evidence-based decision aids can limit decisions based on cognitive errors and biases while also limiting decisional conflict.

In another study, we found that surgeons have a higher prevalence of at least one non-traumatic pain than patients and were more likely to report pain at more than one anatomical site (2). Patients were more likely to receive any treatment and missed more work. Our interpretation of these findings was that surgeons have, on average, relatively effective coping strategies, allowing them to maintain their life roles with limited medical care when in pain. Increasing the appeal and availability of methods for optimising coping strategies might help to narrow the gap between surgeon and patient health.

Evidence from another study showed that surgeons deciding between two treatment options, when the evidence is inconclusive, fall back to factors that relate to their circumstances and reflect their culture more so than factors related to the patient’s perspective (3). Hand surgeons might benefit from consensus fallback preferences when evidence is inconclusive. It is possible that falling back to personal comfort makes physicians vulnerable to unhelpful commercial and societal influences.

We have the impression that provider uncertainty arises from either nonspecific pathology or disproportionate symptoms and disability, both of which correlate with symptoms of depression, heightened illness concern, and low patient self-efficacy. One initial study found no correlation between provider confidence and patient self-efficacy (4).  

References

1. Janssen SJ, Teunis T, Guitton TG, Ring D; Science of Variation Group. Do Surgeons Treat Their Patients Like They Would Treat Themselves? Clin Orthop Relat Res. 2015 Nov; 473(11):3564-72. doi: 10.1007/s11999-015-4304-z. PubMed PMID: 25957212; PubMed Central PMCID: PMC4586191.
2. Bernstein DN, Sood A, Mellema JJ, Li Y, Ring D. Lifetime prevalence of and factors associated with non-traumatic musculoskeletal pains amongst surgeons and patients. Int Orthop. 2016 Nov 18. [Epub ahead of print] PubMed PMID: 27864586.
3. Hageman MG, Guitton TG, Ring D; Science of Variation Group. How surgeons make decisions when the evidence is inconclusive. J Hand Surg Am. 2013Jun; 38(6):1202-8. doi: 10.1016/j.jhsa.2013.02.032. Epub 2013 May 4. PubMed PMID: 23647639.
4. Hageman MG, Bossen JK, King JD, Ring D. Surgeon confidence in an outpatient setting. Hand (N Y). 2013 Dec;8(4):430-3. doi: 10.1007/s11552-013-9533-6. PubMed PMID: 24426961; PubMed Central PMCID: PMC3840763.