When it comes to making decisions about our health, we typically consider doctors the highest authority. Still, they’re not the only experts involved in our care. A primary care doctor, for instance, might refer a patient with diabetes to a registered dietitian for nutritional counseling. But what happens if the dietitian tells the patient that sugar is fine in small amounts, when the doctor has already advised a sugar-free diet? Who should the patient listen to?
Dietitians are allied health practitioners, an umbrella term for different types of credentialed, nonphysician providers who work closely with doctors and play an important role in modern medicine, says Dr. Robin DiMatteo, distinguished professor emerita of psychology at the University of California, Riverside, and a consultant and lecturer on healthcare delivery. Allied health practitioners, which make up about 60 percent of the US healthcare workforce, also include occupational and physical therapists, midwives, speech and language pathologists, and optometrists.
Doctors and allied practitioners offer complementary services and operate as teammates, but they also sometimes dole out conflicting advice. While this can be awkward and confusing for patients, experts say knowing how to navigate the situation makes a difference. Here’s what to know (and do) if you receive competing recommendations from different providers.
Why would doctors and allied practitioners give conflicting advice?
Providers apply the same guideline differently in practice
Both physicians and allied health practitioners use scientific research and clinical guidelines to inform treatment decisions, says Dr. Marilyn Tan, director of the Stanford Endocrine Clinic. It’s their responsibility to keep up with any changes to guidelines.
Still, “their advice can conflict, even though both clinicians actually share the same awareness of the uncertainties, alternative answers, different possible therapies and so forth,” says Dr. Judith Hall, a professor of psychology at Northeastern University who studies physician-patient interactions. One reason, she says, is that “clinicians sometimes think patients can’t handle ambiguity and want just simple, clear-cut opinions and advice.”
For example, both corticosteroid injections and physical therapy are clinically indicated treatment options for knee osteoarthritis. But if a provider believes injections would be more beneficial than physical therapy, they might only mention the first approach, assuming a nuanced evaluation of multiple treatment possibilities will just confuse the patient.
It’s also possible that a provider is aware of the clinical guidance for a medical condition, but believes it’s either flawed or not applicable to a specific patient based on experience treating that condition. So, with the interest of the patient in mind, the provider suggests an alternative approach.
Patients share different information
A provider’s recommendations are always shaped by what they know about a patient.
“Different professionals may not be eliciting the same kind of information from patients,” says Hall. Compared to a doctor, for example, an occupational therapist might ask more detailed questions about a patient’s physical abilities and home environment before recommending a plan to resume everyday activities after surgery.
“Allied health practitioners generally do spend more time with patients, so they are able to gain a deeper understanding of the issues and a holistic perspective of the patient’s condition,” says Dr. Phyllis King, president of the Association of Schools Advancing Health Professions and vice provost at the University of Wisconsin-Milwaukee.
So, what should you do in this situation?
In response to conflicting advice, a patient might instinctively heed the recommendation more closely aligned with their own beliefs, DiMatteo says, or listen to the provider they like better. Or they might ignore both and do whatever they want, since witnessing two experts disagree can erode confidence in both of their opinions. Hall says a patient faced with this cognitive dissonance might seek to resolve it by becoming “more firmly attached to one line of advice than they should, or they can disparage the ‘other’ practitioner in an unjustified way.”
The good news, Hall says, is that patients can take measures to avoid falling into these traps.
Ask the provider to explain their reasoning
Healthcare providers consider a variety of factors when they make treatment recommendations. When you receive clashing advice, DiMatteo suggests asking your doctor or allied health practitioner to think out loud, explaining what they took into account to reach their conclusion. Doing this can help patients unearth implicit beliefs driving a provider’s recommendation.
Let’s revisit the hypothetical case of the diabetic patient receiving conflicting diet advice: Maybe the doctor believes most people lack the willpower to eat only a small amount of sugar. In their mind, telling diabetic patients to cut back on sugar (rather than give it up altogether) only sets them up for failure. If the patient is aware of their doctor’s rationale, the dietitian’s “low-sugar” advice won’t seem as out of step.
Knowing the “why” behind a provider’s medical advice opens up the conversation, making it easier for a patient to ask about alternative treatment approaches.
“Sadly,” Hall says, “patients are often afraid to tell one professional about another professional’s conflicting advice, because it seems like a challenge.”
Hall says you can politely inform one provider about the other one’s recommendation, and ask them to help you make sense of their differing opinions. By getting a provider’s take on the whole situation, you’ll learn more about the health issue in question. You’ll also send the message to your provider that you plan to be an active participant in your care, rather than a passive recipient of advice.
Encourage your providers to come to an agreement
Ideally, your providers will discuss their conflicting recommendations with each other, rather than just going through you. Tan prefers providers to talk and reach a consensus before involving the patient. “It shouldn’t be up to the patient to decide whose advice is more appropriate,” she says.
If both providers stick to their positions, take time to mull over the options
It’s perfectly fine to take a few days to think about which provider’s advice you’d like to try, says Dr. Aisha Langford, assistant professor of population health who researches patient decision-making at NYU Grossman School of Medicine. Ask permission to contact them again if you have questions.
To make an informed decision, Langford advises seeking out credible information from sources like MedlinePlus and medical society websites. You can also use decision aids, which are designed to help patients weigh treatment options laid out by providers. The Ottawa Hospital Research Institute has a database of decision aids for different health-related issues. If it doesn’t include your specific issue, here’s a generic personal decision guide.
If you want to try both approaches, work with your providers to formulate a plan
“Sometimes, it’s a question of what you want to try first,” says Langford. For example, between corticosteroid injections and physical therapy, a patient might decide to give physical therapy a whirl first.
Tell both providers which approach you want to start with. Ask them to break down the process: how long to stick with physical therapy, how to assess its efficacy and what information or observations (if any) you should record for medical monitoring. Have them explain if and how you’ll switch from physical therapy to injections, vs. getting injections while continuing PT.
Also, come up with a communication plan to keep everyone in the loop — both providers should be aware of how you’re responding to each treatment.
It’s a healthcare provider’s job to help you manage your health; neither a doctor nor an allied practitioner will abandon you because you don’t choose their recommended treatment approach. “Most healthcare professionals want their patients to be successful and want to be a team player with you,” says Langford.