Can You Trust Your Doctor?
Considering the moral hazard and a doctor's competence is crucial.
Posted January 16, 2019
With cold and flu season at its yearly high, I guess I won’t be the only one feeling under the weather. For days I’ve been trying to fight off a sore throat, headache and runny nose, but as my temperature rises, I officially declare defeat.
The symptoms of viral infections causing colds may be common (hence the term “common cold”) but the experience certainly isn’t. Yes, I know most colds are harmless. Yes, I know I’ll feel better in a couple of days. But man, right now, I feel lousy.
Even if slurping chicken soup by the bucket, it’s hard to find comfort when the whole body is aching. Usually not even a doctor's appointment can offer relief. I know what I’m talking about—I’ve married a doctor! With my husband seeing dying patients every day, he really doesn’t care too much about my sniffles. What’s more, his predictable advice of staying hydrated and popping paracetamol often leaves me feeling frustrated.
In situations like these, it is only too natural to doubt your health practitioner. Some patients fall into the trap of overpriced (and typically rather useless) herbal remedies. Others turn to “Doctor Google," and search the web for alternative treatment or more powerful drugs. This frequently leads them to antibiotics.
The common cold and antibiotics
Since the discovery of penicillin in the early 20th century, antibiotics have acquired an almost mythical reputation as super drugs. The idea that bad colds should be treated with antibiotics therefore doesn’t sound far-fetched. Yet, it is misguided.
Antibiotics are a class of drugs that only act against bacterial infections such as pneumonia, salmonella or meningitis. In the case of colds and flu—both viral illnesses—no amount of antibiotics will ease your symptoms. Instead, you may start suffering from antibiotic side effects such as stomach upsets and diarrhoea. Taking antibiotics unnecessarily will also contribute to increasing levels of antibiotic resistance. This refers to bacteria developing resilience to existing drugs, meaning that bacterial illnesses may become untreatable in the future.
So it’s bad news: When it comes to the common cold, there seems to be very little you can do apart from rest. Self-care is the best strategy, and you may want to give this comforting yoga sequence by fabulous online yoga coach Adrienne Mishler a go. Alternatively, just watch lots of daytime TV. Or sleep.
Should you trust your doctor?
It looks like your doctor may just be right about the common cold, but does that mean you should always trust your physician’s advice?
The role of patients is intrinsically vulnerable. Upon consulting a medical practitioner, the patient enters into what decision theorists call a “principal-agent relationship." This is a relationship characterised by an asymmetry of power and information, where doctors have unique prescribing authority and more medical knowledge than patients (after 4-7 years of med school, one would certainly hope so).
To judge whether to trust a doctor’s treatment decisions, two crucial aspects need to be considered.
- Moral hazard
The moral hazard refers to the problem created by a possible conflict of interest between doctor and patient. Luckily, there is a natural overlap between the interests of patients, who mostly want a speedy recovery, and doctors, who mostly want to help their patients. Furthermore, positive patient outcomes also contribute to a doctor’s good professional reputation, which can lead to promotions and pay rises. On the whole, there exists very little reason for a doctor to act against a patient’s wishes—phew!
However, it gets more difficult for complex healthcare systems characterised by so-called “double-agency” problems. Double-agency describes situations where decision makers have to answer to different stakeholders. In the health context, for example, doctors report to both their patients and to the management of the practice, hospital, or organisation they work for. Challenges arise if medical management set organisational targets such as a limited number of hospital referrals or restricted amounts of drugs dispensed.
And double agency gets even more complicated in private health care systems, which may be affected by additional incentives, for example through private funding. Disproportionate influences of pharmaceutical companies, for example, could present doctors with financial incentives to prescribe particular brands of drugs and medication rather than others, thus biasing their decision making. Luckily, most countries now have strict regulations to minimise unduly influences of pharma concerns, but exceptions remain.
As mentioned before, the principal-agent relationship of doctors and patients is inherently imbalanced. Patients lack knowledge about their doctor’s capabilities and they rarely have the means of assessing their doctor’s performance. While a thorough medical education is prerequisite for practising medicine in most countries, this does not mean all doctors are experts in all health problems. I certainly wouldn’t recommend asking my husband (an adult diabetes doctor) for advice on newborn babies. Furthermore, no amount of education can prevent human error or temporary lapses in judgement and concentration.
So what can we take away from this analysis? Overall, the results are re-assuring: In most cases we have no reason to distrust our doctor. Medical practitioners are typically well-educated individuals who entered a challenging profession in order to help other people (thanks, by the way). So even if you are tired of hearing the same treatment advice for colds again and again, you might do well to follow it. Only in exceptional cases may it be necessary to seek a second opinion. This includes situations where doctors’ interests differ from your own; for example, due to organisational targets. It also includes incidents of human error. While most healthcare systems have rigorous safety standards, some mistakes are unavoidable. However, rather than punishing your doctor with distrust, engagement and vigilance can help you recognise or even prevent such errors. Ultimately, this watchful trust of patients can contribute to making healthcare safer for everybody.
Tarrant, C., Colman, A.M., Chattoe-Brown, E., Jenkins, D. R., Mehtar, S. Perera, N., & Krockow E.M. (2019) Optimising antibiotic prescribing: Collective approaches to managing a common-pool resource. Clinical Microbiology and Infection, 25(11), 1356-1363. doi:10.1016/j.cmi.2019.03.008