J Med Ethics doi:10.1136/jme.2010.040618
  • Clinical ethics

Predictors of hospitalised patients' preferences for physician-directed medical decision-making

  1. David O Meltzer4
  1. 1Undergraduate College, The University of Chicago, Chicago, Illinois, USA
  2. 2Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
  3. 3Department of Medicine, Section of General Internal Medicine, The University of Chicago, Chicago, Illinois, USA
  4. 4Department of Medicine, Section of Hospital Medicine, The University of Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Farr A Curlin, The University of Chicago, 5841 S Maryland Ave, MC 2007, Chicago, IL 60637, USA; fcurlin{at}
  • Received 17 October 2010
  • Revised 17 May 2011
  • Accepted 24 May 2011
  • Published Online First 22 June 2011


Background Although medical ethicists and educators emphasise patient-centred decision-making, previous studies suggest that patients often prefer their doctors to make the clinical decisions.

Objective To examine the associations between a preference for physician-directed decision-making and patient health status and sociodemographic characteristics.

Methods Sociodemographic and clinical information from all consenting general internal medicine patients at the University of Chicago Medical Center were examined. The primary objectives were to (1) assess the extent to which patients prefer an active role in clinical decision-making, and (2) determine whether religious service attendance, the importance of religion, self-rated spirituality, Charlson Comorbidity Index, self-reported health, Vulnerable Elder Score and several demographic characteristics were associated with these preferences.

Results Data were collected from 8308 of 11 620 possible participants. Ninety-seven per cent of respondents wanted doctors to offer them choices and to consider their opinions. However, two out of three (67%) preferred to leave medical decisions to the doctor. In multiple regression analyses, preferring to leave decisions to the doctor was associated with older age (per year, OR=1.019, 95% CI 1.003 to 1.036) and frequently attending religious services (OR=1.5, 95% CI 1.1 to 2.1, compared with never), and it was inversely associated with female sex (OR=0.6, 95% CI 0.5 to 0.8), university education (OR=0.6, 95% CI 0.4 to 0.9, compared with no high school diploma) and poor health (OR=0.6, 95% CI 0.3 to 0.9).

Conclusions Almost all patients want doctors to offer them choices and to consider their opinions, but most prefer to leave medical decisions to the doctor. Patients who are male, less educated, more religious and healthier are more likely to want to leave decisions to their doctors, but effects are small.


  • The study's contents are solely the responsibility of the authors and do not represent the official views of the funding agencies. GSC and FAC had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding Financial support for this work was provided by the Agency for Healthcare Quality and Research through the Hospital Medicine and Economics Center for Education and Research in Therapeutics (CERT) (U18 HS016967-01, Meltzer, PI), a Midcareer Career Development Award from the National Institute of Aging (1K24 AG031326-01, Meltzer, PI) and the Robert Wood Johnson Investigator Program, (RWJF Grant ID 63910 Meltzer, PI). FAC was supported by a career development award from the national Center for Complementary and Alternative Medicine (1K23 AT002749-01A1).

  • Competing interests None declared.

  • Ethics approval This study was conducted with the approval of the University of Chicago, Biological Sciences Division Institutional Review Board under Protocol 9967.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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