Individuals facing a medical dilemma are more likely to choose a riskier course for themselves than for others.

Researchers at the University of Michigan and the V.A. Ann Arbor Healthcare System asked 2,400 participants in an online study to play one of four roles: a patient deciding on individual treatment, a parent choosing for a child, a physician advising a patient, or a medical director setting guidelines for many patients. The volunteers were then asked to imagine a serious flu outbreak that presented a 10 percent chance of causing death and were given the option to take a new flu vaccine that carried a 5 percent chance of being fatal.

People playing the parent, doctor and medical director roles were all more likely to choose the vaccine than those playing the self-treating role. Responses followed a similar trend when participants were presented with a cancer scenario and the choice to have chemotherapy or not. The outcomes represent the phenomenon of “omission bias”—choosing inaction over action, even at the risk of greater harm.

Study leader Brian J. Zikmund-Fisher, who holds research positions at the university and the V.A., notes that even though actual patients in recent years have become increasingly involved in making treatment choices, the study emphasizes why clinicians should not become less involved. “There remains an important role for coaching the decision-making process,” he says—“helping patients to see the big picture.”

Zikmund-Fisher is planning follow-up work that will examine the effect of perspective on decisions made in end-of-life settings, such as choosing symptom-relieving care versus aggressive treatments that could prolong life but at a lower quality.