Neurosurgical decision making: personal and professional preferences

Area of Science:

• Neurosurgery
• Medical Decision-Making
• Cognitive Bias in Medicine

Background:

• Physicians often face requests for personal clinical recommendations.
• The act of recommendation can influence patient care decisions.
• Understanding neurosurgeons' personal treatment preferences is crucial.

Purpose of the Study:

• To examine how neurosurgeons value procedures when considering their own treatment versus patient recommendations.
• To investigate potential discrepancies in treatment choices across various neurosurgical scenarios.

Main Methods:

• An online survey was distributed to neurosurgeons via the Congress of Neurological Surgeons listserv.
• Respondents were randomized to answer from either the surgeon's or patient's perspective.
• Data included practice parameters, experience levels, and responses to distinct neurosurgical scenarios.

Main Results:

• For vestibular schwannoma and arteriovenous malformation, more surgeons chose resection for patients but radiosurgery for themselves.
• Treatment preferences varied based on neurosurgeon specialization (e.g., tumor focus) and experience (years post-residency).
• Less invasive options were favored for personal treatment in scenarios involving aneurysms and hemorrhages.

Conclusions:

• In some neurosurgical scenarios, surgeons' personal treatment choices differ from those recommended for patients.
• Less invasive interventions were preferred for self-treatment in specific conditions like vestibular schwannomas and aneurysms.
• These differences may stem from cognitive biases, training, expertise, and personal values.