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.