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 said.
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.