Most physicians are so poor at communicating medical information
to their patients that up to half of all patients leave their
physician's office without understanding what they have been told
about their medical condition, treatment regimen, or prescription
requirements, M. Robin DiMatteo, PhD, said at a conference on
communicating risk to patients, sponsored by the United States
Pharmacopeial Convention, Inc.
Physicians spend, on average, only 5% of each hospital or office
visit providing information to their patients, said Dr. DiMatteo,
a psychologist who has conducted research on the behavior of physicians
and patients in the treatment encounter and on the communication
of medical information to patients.
Moreover, physicians often discourage their patients from voicing
their concerns by using "coercive" methods, such as
interrupting and clock watching, she noted. Patients often respond
to this coercion, either consciously or subconsciously, by being
noncompliant, said Dr. DiMatteo, who is also Professor and Chairman
of Psychology, University of California, Riverside. In fact, Dr.
DiMatteo said, her research indicates that about 40% of patients
do not adhere to their prescribed treatment regimens.
Risks and Benefits
When it comes to telling their patients about the risks and benefits
of treatment, physicians discuss risks only about 14% of the time
and treatment alternatives only 12% of the time, she said. When
physicians do bring up these issues, it is often at the very worst
time--such as the morning of surgery or after a treatment decision
has been made, she said.
But discussion of risks should be central to any treatment decision,
Dr. DiMatteo said. Once the risks and benefits of various treatment
regimens are outlined, patients need time to think these issues
over and talk with people who may have opposing views, such as
other physicians or family members. Disclosure of remote risks
also should be brought up, along with the risks of doing nothing.
Physicians should also remember that the ways in which risks are
presented will affect how they are perceived by patients, she
said. Telling patients that they have a 75% chance of living,
for example, will be received very differently than telling them
they have a 25% chance of dying.
When discussing risk, physicians need to consider whether a patient's
goals are different than their own. In fact, the patient's goals
are usually more complex than the physician's, according to Dr.
DiMatteo. Oncologists, for example, often want to treat their
patient's cancer as aggressively as possible--even though it may
adversely affect the patient's quality of life. The goal of the
cancer patient, however, may be to treat the cancer while maintaining
a good quality of life with minimal pain.
Only the patient can define what quality of life means to him
or her, Dr. DiMatteo said. Life as the patient wants to live it--not
as the physician believes it should be lived--is the goal of medical
care, she said.
Physicians have a duty to assess available information about risks
and benefits before they present it to their patients, Dr. Edmund
Pelligrino said in his presentation. Dr. Pelligrino is the John
Carroll Professor of Medicine and Medical Ethics, and Director
of the Center for Clinical Bioethics, Georgetown University School
of Medicine. Physicians often do not have adequate information
about risks, and this must also be communicated to patients, he
There are no specific formulas about how much risk patients should
be informed of, he said. In general, however, patients need to
know the most about highly probable risks and side effects, and
less about those of low probability, he said.
Treatment decisions must be free of coercion from the physician.
This does not mean that a physician cannot say what he or she
thinks is best for the patient. "But there is a fine line
between coercion and persuasion," Dr. Pelligrino said.