HEALTHCARE
December 1, 2012

New Frontiers in Medical Miscommunication

Patients often surprise their doctors by choosing different treatments than their doctors expect. Knowing all the options helps.

There's a new wrinkle in doctor-patient communication. Not only are many patients reluctant to assert themselves and ask questions, discrepancies often also exist between what doctors think patients want, and what patients actually report they want.

Added to these dynamics of miscommunication is the fact that patients often make different decisions regarding treatment if they become better informed about their options, according to Glyn Elwyn, a visiting scientist at the Dartmouth Center for Health Care Delivery Science, and the corresponding author on a new British study of doctors' misperceptions of patients' preferences. It is often a good idea to ask if there are other treatment options, Elwyn, told TheDoctor.

Patients can also ask what would happen if they did nothing. “That’s a viable question,” he says.

If you ask your doctor to describe your options for treatment, make sure you pose the important follow-up question: Are these various alternatives likely to lead to benefit or to harm? Elwyn says that those three questions are very powerful in terms of helping a patient understand what, if any, other treatment options are available, and if so, the relative merits of each.

Patients often make different decisions regarding treatment if they become better informed about their options.

Knowing one's options, however, isn't the same as making a decision; and options often complicate decisions. There are actually some tools available to assist patients in decision making, though they are not common right now. According to Elwyn, the most reliable way of finding a decision support tool to use is to ask your doctor or nurse if there is a decision aid that he or she recommends.

“In our research group, we have been making what we call option grids, which are short, paper-based tools to help patients compare treatment options,” Elwyn says. To date, 11 of them have been published, and they are freely available online without any password.

Elwyn and his colleagues did an overview of previous clinical trials. They found evidence suggesting that doctors misunderstand patient preferences fairly frequently. In one study, doctors believed that 71 percent of patients with breast cancer would feel that keeping their breast is a top priority; however, just 7 percent of patients said that preserving their breast was important to them.

In the same study, doctors believed that 96 percent of breast cancer patients considering chemotherapy would rate living as long as possible a top priority; yet, only 59 percent of patients reported that prolonging life was important. And in a study of dementia, patients placed significantly less value than doctors believed on the continuation of life with severely declining cognitive function.

The scientists also say evidence shows that patients often choose different treatments after they become better informed about the risks and benefits. One study found that 40 percent fewer men preferred surgery for benign prostate disease once they were informed about the post-operative risk of sexual dysfunction.

Elwyn says that these findings did not surprise him or his colleagues. “This is a summary of what we have been noticing over the last few decades really. It’s a point of view that we hold, knowing the literature and the evidence as we do.”

The paper was published in the British Medical Journal.

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