Conflicts Between Non-Directive Counseling and Unbiased Patient Care: the Influence of Medical Students’ Personal Beliefs on Proposed Huntington’s Disease Genetic Testing Recommendations

Abstract

Background

Non-directive counseling is a key component of physician-patient interactions, yet adequate education on this topic is limited in medical education. In this study, we examined whether students would have bias or instead would use non-directive counseling in the specific example of genetic testing for Huntington’s disease.

Methods and Findings

First-year medical students were surveyed if they would personally obtain genetic testing and how they would counsel patients in the following three clinical genetic testing scenarios: pre-symptomatic, diagnostic, and prenatal. Student recommendations were analyzed for how many students picked the standard practice of care extrapolated from the technical standards of the Huntington’s Disease Society of America. Fifty-one of ninety-two students (55.4 %) correctly remained neutral for their counseling of patients regarding pre-symptomatic testing. Sixty-eight of ninety-one students (73.9 %) correctly encouraged genetic testing in the diagnostic clinical scenario. Twenty-nine of ninety-two students (31.5 %) correctly remained neutral for counseling on prenatal testing when the patient would terminate her pregnancy if the fetus were found to have HD. Twenty-two of ninety-two students (23.9 %) correctly discouraged testing when the patient would not terminate her pregnancy.

Conclusion

The results suggest that students may lack the expertise needed to appropriately counsel patients for genetic testing. This may possibly be due to personal bias, which was especially evident in the prenatal testing scenario. Students would benefit from further training to understand how to analyze a variety of commonly encountered clinical scenarios in order appropriately provide non-directive counseling that preserves patient autonomy.