Doctors are notorious for criticizing patients who don’t take medications as prescribed.

But physicians and their families are themselves less likely than everyone else to comply with medication guidelines, a new, large-scale study has found.

People tend to adhere to medication guidelines about 54% of the time, while doctors and their families lag about 4 percentage points behind that, according to findings published recently in the American Economic Review journal.

“There’s a lot of concern that people don’t understand guidelines, that they’re too complex to follow, that people don’t trust their doctors,” said co-researcher Amy Finkelstein, a professor with the MIT Department of Economics. “If that’s the case, you should see the most adherence when you look at patients who are physicians or their close relatives.

“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,” she said in an MIT news release.

For the study, the researchers examined 63 prescription drug guidelines and how well Swedish patients adhered to them. The research involved nearly 5.9 million people, including about 150,000 who were either doctors or close relatives.

Researchers combined health care data with information on prescription drug purchases to see whether people’s medication decisions matched their medical circumstances.

Six of the guidelines pertained to antibiotics, 20 to medication use by the elderly, 20 on drugs for particular diagnoses, and 17 about prescription drug use during pregnancy.

Out of the 63 guidelines, doctors and their families followed the standards less often in 41 cases.

Doctors don’t stick to the guidelines because they think they possess “superior information about guidelines” for prescription drugs, and use their expertise to guide their own use, the researchers said.

The research team pointed to the guidelines for antibiotic use, an area where doctors have the lowest adherence relative to laypeople. Doctors and their families are more than 5 percentage points lower in compliance than everyone else.

Most guidelines recommend that patients first be given more targeted “narrow-spectrum” antibiotics rather than “broad-spectrum” antibiotics — a strategy designed to lower the risk of promoting antibiotic resistance.

“From a public-health perspective, what you want to do is kill it [the infection] off with the narrow-spectrum antibiotic,” Finkelstein said. “But obviously any given patient would want to knock that infection out as quickly as possible.”

“You can imagine the reason doctors are less likely to follow the guidelines than other patients is because they … know there’s this wedge between what’s good for them as a patients and what’s good for society,” she continued.

Doctors also were likely to personally flex the guidelines surrounding drugs where data about side effects is slightly weaker.

For those drugs, doctors and their families have an adherence rate more than 2 percentage points below other folks. But for drugs where there’s slightly stronger evidence of side effects, there’s only about a 1 percentage point difference.

“The results imply that probably what’s going on is that experts 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,” said Maria Polyakova, an assistant professor of health policy at Stanford University School of Medicine in California.

Additional research should look into whether lower expert adherence with drug guidelines is associated with better health outcomes, the researchers said. In other words, this would determine how often doctors have a point.

“An important avenue for further research is to identify whether and when non-adherence is in the patient’s best interest,” the researchers concluded.

More information

The U.S. Food and Drug Administration has more about the importance of taking medications as prescribed.

SOURCE: MIT, news release, Dec. 16, 2022

Source: HealthDay