Talk to Your Doc to Avoid Cookie-cutter Care

August 24, 2010

Does your doctor know what you want?

Doctors generally lack a good understanding of their patients’ beliefs and desires–but the doctors’ knowledge improves a lot when patients ask questions and discuss their preferences.  So says a study published last month in the Journal of General Internal Medicine, summarized in ScienceDaily, and brought to our attention by a kind reader.  (Thanks!)

The study examines more than 200 physician-patient encounters.  It was conducted by Richard Street of Texas A&M University and Paul Haidet of Pennsylvania State University.

two physicians grab a patient's chinLike most advocates of better physician-patient communication, Street and Haidet call on physicians to ask patients for their views.  For decades, such advice has been falling on doctors’ mostly deaf ears.  A patient who wants to be heard probably has to take the initiative. That’s the main point of this blog–and our book.

Conversation between the physician and patient is an essential element of care that is “personalized” or “tailored” or “patient-centered”–all terms that mean just about the same thing.  Read the rest of this entry »

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Readers Share Their Experiences

August 17, 2010

Take a look at three experiences that readers have shared with me during the past few days.

“Connie” has been visiting doctors because of a problem that might involve one or more organ systems–or might be nothing significant.  Apparently, the radiologist now wants to run a third test.  photo of MRI machineConnie wonders whether such extensive testing is worth the risks of possibly excessive exposure to radiation.

Radiology is indeed an area of overuse.  Yale University radiologist Howard Forman told an Institute of Medicine workshop last year that the demand for “one more test”–often supported by the argument, “Don’t you want to rule out a really serious disease?”–leaves patients unprepared to resist unnecessary imaging tests.

Researchers have found that (except for mammography) “habit, anecdotes, and biases”–including a desire to avoid malpractice liability for undetected cancers–play the greatest role in physicians’ recommendations for imaging tests.  Benefit-cost analysis and benefit-risk analysis play only a small role.

Connie might be wise to consult with her primary care physician (see our Aug. 3 post on primary care, below).  She’s entitled to a plan of care that lays out exactly what measures will be taken, depending on potential clinical and test findings.  Otherwise, she may continue to lurch from test to test, with no resolution in sight.

Connie will have the best chance of persuading her primary care doc to help develop a care plan if she plans her visit (as discussed in our book in section 1 on “Presenting a Problem to a Physician,” available on this site at no charge).  She also could bring an advocate with her (section 7 is on “Bringing a Friend with You to the Doctor”).

Read the rest of this entry »


Communication Failures Swamp Hospitals

August 13, 2010

In another case of proving the stunningly obvious, a new study has found that hospital patients and their physicians have dramatically different recollections of their conversations.  Here’s what was found, why it matters, and what individual patients–not just the notoriously slow-to-act medical establishment–can do about it.

doctor in vast hospital corridorAs reported yesterday by HealthLeaders Media, the study involved 89 patients and 43 physicians at Waterbury Hospital, a teaching center in Connecticut.  Conducting the study were the hospital’s chief primary care resident and the associate director of its primary care program (see our Aug. 3 post on primary care, below).  The prestigious Archives of Internal Medicine published the study report.

Among other findings, the study found:

  • Only 18 percent of patients could name their attending physician, although 67 percent of the physicians said the patients knew their names.
  • A mere 10 percent of patients said the doctors advised them about adverse effects of newly prescribed drugs, although 81 percent of physicians said they did.
  • Most patients (54 percent) said physicians did not discuss the patients’ fears and anxieties, although nearly all physicians claimed to have discussed them. Read the rest of this entry »

Doctor Rating Systems: Not Much There

August 11, 2010

News media and commentators are giving greater attention to doctor ratings compiled by health plans, online forums, and other groups to aid patients and families in selecting physicians.   These rating systems aren’t very helpful, for a slew of reasons:

  1. As a Washington Post article noted last week, most ratings ignore physician-patient communication–whether the doctor is skilled and committed in listening, explaining, and asking questions about the patient’s concerns.
  2. Health plan rating systems emphasize performance factors that matter most to the plan, not to the patient.  These include factors like (a) keeping costs down by not ordering a lot of tests and procedures, and (b) following  the plan’s protocols.  test result showing scores of 33% social, 33% scientific, and 33% political
  3. 3. Online forum rating systems, along with similar listings such as magazine ratings, are not based on any set criteria.  Basically, they’re just impressions and lack scientific validity.  (We here have been really pleased with a computer technician we found through Angie’s List, but I have no intention of using Angie to identify someone as important to me as a surgeon or cardiologist.) Read the rest of this entry »

Primary Care: The Key Patient Interface

August 3, 2010

Most visits to a doctor are visits to a primary care physician–typically a family doctor, general internist, or sometimes a general pediatrician or obstetrician-gynecologist–who is responsible for the patient’s routine medical care.  If you develop a productive, satisfying relationship with your primary care practitioner, you will be well along the way to effective communication with all your health care providers, present and future.

patient in examining roomLet’s start by looking at what primary care is, and why it’s important.   This is almost holy ground for me.  My first job after school was to work on an Institute of Medicine study that developed the authoritative definition of primary care, still widely cited decades later.  We said primary care is “accessible, comprehensive, coordinated, continuous, and accountable care.”

In other words, the primary care practitioner is your portal to the health care system and, more than that, oversees all your health care, from episode to episode, as your agent.  You can, for example, use him or her to:

  • refer you to any type of specialist and, afterward, help you decide whether to undertake a procedure the specialist recommends
  • answer any of  your questions about changes in your health or about health-related ideas you’ve encountered, and
  • give you useful instructions for preventing disease or managing your own self-care in light of your lifestyle and resources.

This is a terrific deal!  Researchers have found that primary care is “associated with superior health outcomes.” Yet, it generates only a tiny fraction–less than seven percent–of all health care costs.

Read the rest of this entry »