Attitudes of medical students and primary care physicians regarding input of older and younger patients in medical decisions.

Abstract

This study was designed to determine whether medical students, residents, and fully trained physicians differ in their attitudes toward decision-making input by older and younger patients, whether they believe that physicians should have greater input than patients in medical decisions, whether physicians grant different decision-making authority to younger versus older patients, and whether physician gender affects attitudes toward patient input in medical decisions. Respondents (n = 818) were first- (n = 311) and third-year (n = 227) medical students and family practice and internal medicine residents (n = 120) and faculty (n = 160) from the University of Kansas Medical Center (n = 367) and The Ohio State University Hospital (n = 451) who completed the Beisecker Locus of Authority: Geriatrics Scale to assess attitudes regarding involvement in medical decision making for either a 25- or 75-year-old patient. Respondents were alternately assigned to one of the two patient age vignettes. Analyses included descriptive statistics, t tests, and four-way analysis of variance. Ninety percent of respondents believed that physicians should have greater input in decisions than patients. Female respondents advocated greater patient input than male respondents. As training and experience increased beyond medical school, there was an increased tendency toward belief in physician-only decision making. For the older patient, residents advocated the most patient input and faculty advocated the least. Level of training influenced belief in patient input when its interaction with patient age and institution were examined.