Doctor Style, Research, and Other Weighty Matters

October 28, 2010

Today’s post starts with a summary of another study showing the importance of physician-patient communication, this time in the key and “massive” area of weight loss.  Then we veer into what may be the topic du jour in health policy: the very credibility of research results.  I think you’ll find the discussion interesting–and I’ll be interested in your reactions.

1906 print "Don't Be Fat" ad showing an overweight womanOne of our readers, Trish, noted a study report in the October issue of the  American Journal of Preventive Medicine that ties weight loss in overweight patients to the physician’s style of communication.  (Note, BTW, use of the word “preventive,” not the mouth-contorting “preventative.”)  Patients in the study tended to lose a significant amount of weight if their doctor used “motivational interviewing” that was tailored to the patient’s circumstances and readiness to change behavior.

But, patients tended not to lose weight if the doctor avoided the topic, or if the doctor spoke only in a general, prescriptive, or confrontational way about the importance of losing weight.  It seems we don’t respond well to robotic advice or to nannying.  Surprise.

Nicholas Bakalar reported on the study in the New York Times on October 25.  Bakalar emphasized that “cajoling and coaxing, scolding and reproach are all ineffective.”  What works is “collaborative discussion.”  The latter is exactly the type of conversation promoted in this blog and in our book.

The study, by Kathryn I. Pollak of Duke University and colleagues, involved 40 primary care physicians and 461 patients.

But, here’s the question:  Can we trust the results of studies like this? New findings show that shockingly large numbers of medical studies reflect the researchers’ biases and self-interests and produce inaccurate results.

Read the rest of this entry »

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New Finding: Communication Prevents Death

October 25, 2010

The mortality rate among renal dialysis patients varies tremendously from one dialysis center to another.

Patient in wheel chair awaits dialysis

"Dialysis 3"

Even adjusted for how sick the patients are, mortality is as low as 10 percent in some places, and as high as 30 percent elsewhere.  And, a new study helps explains why.

“More activated and engaged patients,” better “physician communication,”  and “stronger interpersonal relationships” account for much of the difference, say the study report authors. Other factors are more competent dietitians and superior overall coordination and staff management.   Together, these factors explain about one-third of the difference in mortality rates between centers with high death rates and centers with low death rates.

The number of deaths prevented by the better-communicating dialysis centers is probably larger than you might expect.  It appears to run in the tens of thousands every year.  (The overall average mortality rate is about 20 percent.)  In 2008, Medicare alone paid for renal dialysis of more than 450,000 patients.

Read the rest of this entry »


“Shared Decision-Making” and You

October 14, 2010

An excellent new study from  Canada’s Manitoba province explores the factors in successful interaction between patients and their physicians.  I’m interested in what you, our readers, think makes for patient-physician communication success–or failure.

 

photo of decorative church with three spires

Ukrainian Catholic Church, Cook's Corner, Manitoba

 

The study is featured in the Journal of Participatory Medicine, the great new resource we’ve mentioned previously.  Authored by Brenda L. Lovell, Raymond T. Lee, and Celeste M. Brotheridge, the study report assesses the relative importance of many factors.  Physicians in the study identified three major barriers to communication:

  • patients’ failures to follow through with treatment plans or lifestyle changes
  • insufficient time for patient visits, and
  • patients’ failures to understand the diagnosis.

The major barriers to the patient and physician’s  shared understanding, according to the physicians, are:

  • patient presents too many problems
  • patient’s history is rambling and disorganized, and
  • insufficient time.

The major barriers to shared decision-making by the patient and physician, according to the physicians, are:

  • patient does not appear to trust physician
  • patient is uninterested in self-care or health maintenance, and
  • patient does not want to participate in a partnership with the physician.

There are lots of limitations to this study, as the authors note.  (There also are lots of limitations to our own brief summary, above.)   But, it’s important for patients to have a sense of the pitfalls that physicians are on the lookout for.  If you immediately bring one or more of these barriers to the doctor’s mind, he or she is likely to dismiss the possibility of successful communication–and to hurry on the next patient.

After all, what would you do if you had to see dozens of clients every day and the client in front of you gave the appearance of being uncooperative?

In essence, that’s what our book “Make the Health Care System Work for You!” is all about.   We suggest practical ways to become engaged and help create a fruitful partnership with your doctor.  We think the patient is one side of the communication equation and can’t rely on the doctor to do all the work.

The major limitation of the Manitoba study is that it only presents the doctor’s viewpoint.  We need the patient’s viewpoint.  We need to know what pleases or annoys patients who seek a shared understanding and shared decision-making.

Any ideas?

Photo credit:  gurdonarkAttribution.


Young Docs May Be Worse Communicators

October 6, 2010

Provocative findings from a new University of Michigan study suggest that younger,  newer physicians may be even less helpful as patient counselors than their more experienced colleagues.

The implication for patients is to be more directive with most younger physicians than with older ones. We’ll see what that means in a minute.

Reported in the journal Preventive Cardiology and summarized in HealthLeaders Media, the University of Michigan study by Michael Howe and colleagues looks at doctors who treat patients with coronary heart disease at one of the country’s leading academic medical centers–physicians who should be at the top of their field.

photo of huge cheeseburger

"One-pounder at the Heart Attack Grill"

Barely two-thirds of established physicians and one-third of physician trainees (that is, residents and fellows) counseled patients about a healthy diet.  The results were about the same for counseling patients about the benefits of regular exercise.  It would be hard to justify counseling fewer than 90 percent of patients about both issues.

Moreover, few of the experienced or newer physicians reported feeling Read the rest of this entry »