June 12, 2019

Medical decision-making in the UK and US

Doctors’ decisions about treatment for haemophilia are made differently depending which side of the Atlantic they practice, a study shows (Haemophilia 2019 May 5. doi: 10.1111/hae.13766).

The qualitative analysis of the factors that determined haematologists’ treatment choices included 24 clinicians with 23 – 28 years’ experience. US physicians were more inclined to support patients’ choice of treatment; UK doctors followed treatment policies and patients were generally happy to take their advice. In the US, treatment choices are restricted by what is eligible for reimbursement by an insurer but physicians are generally successful in appealing a decision that goes against a patient. However, neither side had much faith in evidence-based guidance because the evidence is not representative of clinical practice and treatment is highly individualised. On both sides, the choice of treatment discussed with patients was influenced by the patients’ health literacy: patients with better understanding of their disorder and greater awareness of its treatment were more likely to have their views listened to.