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BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

Comparing GPs’ risk attitudes for their own health and for their patients’ : a troubling discrepancy?

Authors: Antoine Nebout, Marie Cavillon, Bruno Ventelou

Published in: BMC Health Services Research | Issue 1/2018

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Abstract

Background

In this paper, we report the results of risk attitudes elicitation of a French general practitioners national representative sample (N=1568).

Methods

Willingness to take risks in four different domains (daily life, financial matters, own health and patient health) was collected through a large-scale telephone interview of GPs using self-reported 11-point Likert scale questions.

Results

We uncover some specificities of the GPs population regarding their attitudes towards risk. In particular, we detect an important positive gap between their willingness to take risks in the domain of their own health and in the domain of the heath of their patients. This “patient-regarding” risk aversion is discussed with respect to its important consequences regarding medical behavior bias.

Conclusions

We confirm the self-other discrepancy found in the medical literature on physicians’ behaviors and emphasize the utility of the study and measures of personality traits such as “risk attitudes” for the medical professions and for the population they address.
Footnotes
1
An example of field study on surgeons is presented in [43].
 
2
House calls and at the practice.
 
3
The cutting points were chosen by quartiles defined on the number of acts per year: First quartile-limit is 2849 acts per year, and defines the upper-bound for first quartile (GP with low level of activity). The third quartile is 5494 acts per year and defines the lower-bound for the fourth quartile (GP with high level of activity). The middle class is between 2849 and 5494 acts and defines the 50% of the GPs who have an “intermediary” level of activity.
 
4
We also add the “in the different domains of the daily life” in the general domain following requests from many interviewees of the pilot asking for more details on this specific question.
 
5
The remaining 336 GPs of the Pays de la Loire oversample were proposed another questionnaire with specific questions on regional issues.
 
6
This suggests that own perceptions of the appropriateness of risk taking also affects behavior towards patients.
 
7
This result holds using the continuous age variable in the regression instead of the stratification age variable described above.
 
8
The highest volume of activity (>5494) has a significant positive impact on the willingness to take risks in the financial domain. This could be explained by the fact that GPs with higher activity are wealthier and consequently take more risks [17].
 
9
Note that, in 2004, french women GPs were earning 33% less than men GPs [44].
 
10
This result is contradictory with studies showing that some GPs may be, in practice, take too many risks on behalf of the patients which can lead to detrimental consequences for the patients [45, 46].
 
11
Such risk seeking behavior of GPs concerning their own health is consistent with studies showing that physicians are reluctant to seek help for their own medical issues [47, 48].
 
12
For patient’s health, p=0.18 for the unpaired t-test between the two conditions, p=0.29 for physicians’ health and p=0.84 for the difference between patients’ and physicians’ health.
 
13
We recognize that GPs’ way of responding to the questions may be a reflection of an internalized narrative effect regarding the asymmetrical patient-physician-relationship and the identity of a physician [49]. Only a mirror study with cross collection of data, both on patient’s preferences and on the GPs beliefs of the patient’s preferences could clarify this point.
 
14
And eventually in their ability to correctly threat and interpret this information (although [18] emphasize that doctors may also fall into systematic biases in their statistical analysis).
 
15
GPs might also have better cognitive abilities than the general population, thus explaining the gap because, as suggested by a referee, cognitive performance and risk attitudes may be related [50].
 
16
As suggested by a referee, a test for differential item functioning would be relevant for the likert scale question assessing willingness to take risks in the health domain as it cannot be excluded that this item functions differently in the general population and in GPs.
 
17
Actually, the reader has to accept the idea that a complex issue such as willingness to take a risk on behalf of a patient can be measured by one question phrased in general terms whereas patients’ recommandation behavior relies on the GP’s self-awareness concerning a complex pattern of motives. This is anyway in the line of the results of Dohmen et al (19), who coined the principle that a simple scale elicitation tool could be as efficient as a complex tool, when collecting attitudes toward risk.
 
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Metadata
Title
Comparing GPs’ risk attitudes for their own health and for their patients’ : a troubling discrepancy?
Authors
Antoine Nebout
Marie Cavillon
Bruno Ventelou
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3044-7

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