What are the options, doc?
Sooner or later, a conversation with a physician over a difficult diagnosis comes down to a question like that.
But all too often, doctors are likely to leave stuff out, the results of a recent survey of more than 3,000 patients age 40 and older suggests.
The survey, conducted by the Institute for Social Research at the University of Michigan, found that patients hear far more from doctors about the pros than cons of medications, tests and surgeries.
Much of the time, physicians tend to offer opinions, not options, the researchers found, and rarely mention to patients that they can decide not to do anything.
The study was funded by the Foundation for Informed Medical Decision Making, a Boston nonprofit seeking to give patients more voice in their health care choices.
The Michigan team asked the subjects about decisions they made with health care providers within the past two years regarding common medical issues: screening tests for colorectal cancer, breast cancer and prostate cancer; taking prescription drugs for hypertension, high cholesterol and depression; having surgery for knee or hip replacement, cataracts and lower back pain.
They found that more than three-quarters of the patients had made at least one of those decisions in the past two years and half had tackled two or more.
The study found that doctors, nurses and others were much more likely to talk up the advantages of a treatment or test while skipping the negatives. For instance, only 20 percent of the patients who discussed breast cancer screening said they heard anything about possible downsides, such as false positive results, while 50 percent said they heard "a lot" about the pros of screening.
The patients, on average, were able to answer only about half the questions about four or five pieces of information that experts say are essential to understanding the risks and benefits of a therapy.
For instance, few patients who had discussed cholesterol-lowering drugs knew the most common side effects (headache, nausea, digestive tract problems) or how much a reduction in risk of heart attack can be achieved by taking them (roughly 33 to 50 percent, various studies have shown.)
"The study clearly demonstrates that people routinely make poorly informed medical decisions," said Dr. Michael Barry, president of the foundation and a professor of medicine at Harvard Medical School.
Health policy experts consider it vital that patients fully understand both the benefits and risks of medicine, and that they have the right and power to say no to suggested treatment. Many feel the system is often biased toward doing something, and driving up costs while in reality adding little to overall health or lifespan.
One program called for under the new health reform law (but still not fully funded by Congress) would develop, test and spread educational tools to help patients and their families fully understand treatment options. It also directs government researchers to test shared decision-making models to see if they improve quality of care and reduce costs.
Of course, many of those doctor-guided educational tools would be Web-based.
Which is a good thing, because people are already turning to the Internet for medical information more often, and using it to self-diagnose rather than seeking professional care.
A recent study done for Google found that 75 percent of patients research their condition online before discussing it with a doctor, and 70 percent said they search for more information after consulting a physician. More than a third of the people in the study said they do health searches weekly and 52 percent said they had used information from the Web to self-diagnose.
Another survey done over the summer for the supplemement maker Flexin International found somewhat similar numbers, but with a gender gap: It found that 74 percent of women (aged 35 to 60) routinely turned to the Web first on health issues, but just 44 percent of men did so. True to decades worth of research that find women more in tune with their bodies, the men reported they weren't always sure how to describe their ailments when they tried to use the Web to self-diagnose.
All of this is troubling to doctors like Pamela Hartzband and Jerome Groopman of Boston's Beth Israel Deaconess Medical Center and also medical professors at Harvard.
In a commentary published in The New England Journal of Medicine in March, they argue that while the Internet can provide a wealth of information, "It is too easy for non-experts to take at face value statements made confidently by a voice of authority," they wrote.
They concluded, "The doctor, in our view, will never be optional."
But doctors could stand to be a bit more informative.
geckoaz posted at 11:12 am on Thu, Oct 21, 2010.
Regarding the study of Doctors not providing enough education to their patients: I am a nurse and I agree. Many doctors I work with do not give the patient the time or education they need. They are in and out of their rooms in 10 minutes or less. Much of the explanation and education is placed on the nurse. But per JAHCO, State Board of Nursing, Nursing Scope of Practice and Standards and other organizations that mandate what a nurse can do, the nurse is NOT to provide the explanation only the teaching. There is a difference. Many patients complain they could not understand their doctor because: language used is too technical, foreign accent or rushed speech. Many do not allow the patient time to digest absorb and think about the information given to them long enough to ask questions. Some doctors will ask the nurse about how the patient feels about the information rather than actually seeing them. In the nursing world documenting something you do not do will cost you your license to practice. Nurses are there to support our doctors and to advocate for our patients. We are there to explain what they do not understand but it is up to the doctors to make that first contact. Due to legal issues and changes in medical care costs and provisions, changes are being made to hold these doctors more accountable than before if they want to get paid and avoid a lawsuit. Now on the other side of the coin: I know these doctors are spread very thin. Many have numerous hospitals, long term care facilities, clinics and specialty hospitals for which they travel to to see patients. Many also have either their own practice or are part a group of doctors in a practice. One doctor told me he was spread so thin he was unable to take more patients. His specialty is a high demand with patients but they do not have the doctors to fill space. Similar to education, not enough instructors to teach nursing to accommodate the large population waiting to be taught and be licensed to practice. The pay and legality in regards to lawsuits are another factor that deters more doctors to pursue certain specialties. Lawsuits threats and actions have gotten so out of hand it is affecting the medical community in many ways. How do we solve this problem? It will take the work of many people in many different areas. Medical care, like many other things in society, reacts like the domino effect. If one does not pull their weight or drop the ball, all the rest will struggle. As a nurse, we can only support our Docs and get them to try to spend more time with their patients and be present during rounds to explain what the patient does not understand.[wink]
junglebunny posted at 10:18 am on Thu, Oct 21, 2010.
[smile]No place to leave comment on Phx Police Sgt's death. Sad situation but it smells like a cover-up for a possible suicide.....He shut off his GPS; he never called in to report anything he was going to check upon; his own weapon.....too many questions. If it is true that he took his own life then they should just deal with it and find out the cause.....feel sorry for his family and his friends