Most physicians are so poor at communicating medical information to their patients that up to half of all patients leave their
Most physicians are so poor at communicating medical informationto their patients that up to half of all patients leave theirphysician's office without understanding what they have been toldabout their medical condition, treatment regimen, or prescriptionrequirements, M. Robin DiMatteo, PhD, said at a conference oncommunicating risk to patients, sponsored by the United StatesPharmacopeial Convention, Inc.
Physicians spend, on average, only 5% of each hospital or officevisit providing information to their patients, said Dr. DiMatteo,a psychologist who has conducted research on the behavior of physiciansand patients in the treatment encounter and on the communicationof medical information to patients.
Moreover, physicians often discourage their patients from voicingtheir concerns by using "coercive" methods, such asinterrupting and clock watching, she noted. Patients often respondto this coercion, either consciously or subconsciously, by beingnoncompliant, said Dr. DiMatteo, who is also Professor and Chairmanof Psychology, University of California, Riverside. In fact, Dr.DiMatteo said, her research indicates that about 40% of patientsdo not adhere to their prescribed treatment regimens.
Risks and Benefits
When it comes to telling their patients about the risks and benefitsof treatment, physicians discuss risks only about 14% of the timeand treatment alternatives only 12% of the time, she said. Whenphysicians do bring up these issues, it is often at the very worsttime--such as the morning of surgery or after a treatment decisionhas 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 treatmentregimens are outlined, patients need time to think these issuesover and talk with people who may have opposing views, such asother physicians or family members. Disclosure of remote risksalso should be brought up, along with the risks of doing nothing.
Physicians should also remember that the ways in which risks arepresented will affect how they are perceived by patients, shesaid. Telling patients that they have a 75% chance of living,for example, will be received very differently than telling themthey have a 25% chance of dying.
When discussing risk, physicians need to consider whether a patient'sgoals are different than their own. In fact, the patient's goalsare usually more complex than the physician's, according to Dr.DiMatteo. Oncologists, for example, often want to treat theirpatient's cancer as aggressively as possible--even though it mayadversely affect the patient's quality of life. The goal of thecancer patient, however, may be to treat the cancer while maintaininga good quality of life with minimal pain.
Only the patient can define what quality of life means to himor her, Dr. DiMatteo said. Life as the patient wants to live it--notas the physician believes it should be lived--is the goal of medicalcare, she said.
Physicians have a duty to assess available information about risksand benefits before they present it to their patients, Dr. EdmundPelligrino said in his presentation. Dr. Pelligrino is the JohnCarroll Professor of Medicine and Medical Ethics, and Directorof the Center for Clinical Bioethics, Georgetown University Schoolof Medicine. Physicians often do not have adequate informationabout risks, and this must also be communicated to patients, hesaid.
There are no specific formulas about how much risk patients shouldbe informed of, he said. In general, however, patients need toknow the most about highly probable risks and side effects, andless 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 shethinks is best for the patient. "But there is a fine linebetween coercion and persuasion," Dr. Pelligrino said.