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Physicians Aren't Giving Patients the Whole Story

 |  By jcantlupe@healthleadersmedia.com  
   October 14, 2010

The doctor takes off his glasses, moves his swivel seat behind his desk takes out his prescription pad and writes what medication the patient should receive. He says what should be done, and what is necessary, to help the patient feel better.

Unfortunately, most of the conversations don't go enough into the depth of procedure for the disease or illness involved, leaving many patients unprepared to make fully informed decisions about their care, University of Michigan researchers concluded in a national study and survey about medical decisions. The study was funded by the Foundation for Informed Medical Decision Making.

Too often, physicians are leaving patients  "in the dark" and do not include enough information about sensitive medical decisions such as screening tests for colorectal or breast cancer, the need for prescription medications for hypertension, and issues related to hip replacement, cataracts, and lower back pain, the researchers say. For instance only 20% of patients considering breast cancer screening reported hearing anything about the "cons" of such screening, while 50% reported hearing mostly about the "pros," according to the study.

Generally, the study found that most patients hear far more from doctors about advantages than the disadvantages of medications, the study says. Patients also do not understand essential facts about common medical decisions, or are mostly offered opinions, without their own preference attached.

So it goes:  another study that examines communication issues involving patient and physician, in which seemingly little "tweaks" in the system—improving the one-on-one dialogue, possibly adding more time to the process—could eventually mean a big difference in healthcare.

Variations of the communication theme continually crop up in making the physician-patient experience better.  Recently, I reported from a separate University of Michigan study that physicians lacked the confidence to be totally up front with patients about certain issues, such as the need for weight loss, for instance.

It may seem like a blur for the patient as well as the physician, once it is over, but the impact of even the most routine patient visit to the doctor is a time to glean the importance of what it means, and communication often lags—because crucial information is not imparted to the patient, notes Jack Fowler, PhD, senior scientific advisor for the Foundation for Informed Decision-Making and a co-author of the study.

For instance, in discussions about prescription or medication needs, the "patient could be talking with the doctor about a drug they may have for the rest of their life." They should know "what they are getting into, and what's actually involved." Often, those discussions touch on what the patient is dealing with—but not enough, he says.

A patient truly understanding what is happening in communication with his or her doctor "makes for better medicine," Fowler says. Too often, patients "don't' feel involved in the decision making."

The study also indicates what is needed for healthcare reform and the shared decision-making that involves—or should involve—dialogue between informed patients and their providers, according to Fowler and other Michigan researchers.

As Fowler sees it, the study underscores the provisions in the new health reform law that are designed to improve the dialogue between patient and doctors by promoting "shared decision making" and the use of patient decision aids. Ideally, patients are fully informed about the risks and benefits of every option when making a medical decision and their doctor knows which option they prefer.

"The study clearly demonstrates that people routinely make poorly informed medical decisions, informed consent isn't real if patients understand so little about the tests and treatments they are getting," said Michael Barry, MD, professor of medicine at Harvard Medical School and president of the Foundation for Informed Medical Decision Making in a statement.

In other areas of patient care, such as potentially screening for prostate cancer, only half of the male patients reported having been asked about their preferences by their provider, the study states. There was one area studied showing that patients did seem to know risks and benefits of medication: 70% say they had knowledge of the impact of drugs to control hypertension.

On the other hand, few knew the most common side effects of cholesterol drugs or had an appropriate understanding of how much reduction in the risk of a heart attack can be achieved through taking medication, according to the study.

The improved communication allows patients to be "more involved in their care," Fowler says. And that is one of the key elements—and objectives—of healthcare reform to "bridge the dialogue gaps," he says.

He noted that the law encourages shared decision-making by doctors and patients and particularly to help Medicare beneficiaries make informed decisions wrapped around an understanding of options available and the patient's choices. The idea is to educate patients and caregivers to understand various options.  Among the unfolding questions will be the impact of potentially new decision-making processes, and whether it improves or reduces the quality of are, and also makes a significant dent on costs.

Physicians are standing in the middle of it all, and the potential for improved communication in so many areas, including the dialogue between patients and physicians about specific medications, their impacts, and the importance or lack thereof of particular screenings, is a big part of the process how we improve the healthcare system. Healthcare reform is setting that stage for quality care by evaluating physicians for what they do, and potentially rewarding them, Fowler says, emphatically, "to do better medicine."

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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