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Say What? Do Patients Really Hear What Doctors Tell Them?

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When I had a heart attack two years ago, I was taken immediately from the E.R. to the O.R. for emergency treatment, including cardiac catheterization and a stainless steel stent implanted in my left anterior descending coronary artery that turned out to be 99% blocked.  But, overwhelmed and terrified, I knew nothing of what was about to happen to me, even though I have a vague memory of the cardiologist explaining something to me before I was taken upstairs. I don't think I was even capable of comprehension at the time. What I learned much later was that my tiny stent may help a newly-opened artery to stay open.  But a new study now suggests heart patients believe that stents have far greater benefits than they actually do, the Boston Globe reports

The research, published in the journal' Annals of Internal Medicine, found that over 80% of heart patients who had undergone angioplasty with stents implanted thought that the procedure would cut their odds of having a future heart attack. But about the same proportion of physicians reported to researchers that they had told their patients that stents would do nothing more than simply relieve chest pain.

The Globe calls this a yawning disconnect between what doctors say and what patients hear. This disconnect extends to other types of elective medical treatment as well, resulting in patient confusion and even overuse of some procedures. Cancer patients, for example, often believe that chemotherapy will destroy a tumor, counting on a cure that medical evidence does not promise at all.

Dr. Henry H. Ting from Mayo Clinic told a HealthDay interviewer that he was not surprised by the study findings. He pointed to a Mayo Clinic study that found 80% of patients signed consent forms they had not even read, and did not actually know the benefits or risks of the treatment they were having.

Dr. Ting, who conducts research on informed consent, said the problem of patient understanding is common in many areas of medicine: 'We [doctors] don't do a good job of knowledge transfer in a way that patients and family members can understand. Graphs and charts are not going to work for many of our patients.

One reason for patients' misunderstanding is the common belief, cited in the recent study, that if a treatment is offered, it must have curative benefits.  And apparently some cardiologists are equally confused.

According to the study's authors, for example, fewer than one-third (31%) of those who agreed to undergo elective cardiac catheterization actually' had the type of activity-limiting angina pain that angioplasty might even be expected to ease an appalling statistic which may make you wonder why the procedure was done on two-thirds of these people in the first place. (See also: Cardiologists Accused Of Implanting Cardiac Stents That Weren't Needed.)  The study's authors noted that treatment benefits can often be achieved with medication alone.  Nevertheless, almost three-quarters of all the patients studied still believed that if they didn't undergo angioplasty, they would suffer a heart attack within the next five years.

Where did they get this from? Study authors admit that they were not present during 'informed consent' discussions between patient and doctor, and so had to rely instead on what cardiologists told them they had said to patients.

Only patients who are actually in danger of having a heart attack can expect angioplasty or stent implantation to reduce risk of future heart attacks and death, according to 2007 research cited in the study.

Dr. Richard Frankel, a Regenstrief Institute research scientist at the Indiana University School of Medicine, offers this observation on the classic doctor/patient miscommunication problem: 'We don't assume when a pilot and an air traffic controller converse that they have understood each other until there is an affirmation of understanding. That acknowledgement is lacking in most patient-physician encounters.

Dr. Frankel, who studies ways to improve the doctor-patient relationship, is currently investigating how behavioral changes by both doctors and patients impact medical care. He adds: From previous work, including a well-regarded 1999 study from the University of Washington, we know that doctors ask patients whether they understand what was just discussed less than 2% of the time'Doctors should be trained to routinely check for understanding to ensure that there is neither miscommunication nor mismatch between what the patient wants and what doctors assume the patient wants.

Patients are not to blame for that miscommunication about cardiac stents, says' Dr. Michael Pignone, a medical editor for the Boston-based Foundation for Informed Medical Decision Making.  As a heart attack survivor and now a frequent flyer in our health care system, I tend to agree with Dr. Pignone.  For starters, when two people who are on equal footing are communicating calmly using a similar knowledge base, we might expect a reasonable level of mutual comprehension. Two auto mechanics can talk shop together trusting that they absolutely understand each other. Ditto for two oceanographers. Two accountants. Two computer programmers.  But just try putting one of those two people in a drafty hospital gown, lying confused and vulnerable on an E.R. gurney while suffering distressing physical symptoms. Put the other person in a starched white coat, standing overhead coolly rattling off a jargon-filled explanation of what may or may not happen next. It's a tragic recipe for miscommunication. Should it be up to the person in the drafty gown to ensure that doctor-patient communication is accurate or effective during an emotionally overwhelming medical event?

Doctor-patient communication has been the life's work of the University of Toronto's Dr. Wendy Levinson. Her landmark research comparing doctors who had never been sued for medical malpractice with doctors who had been sued at least twice offers valuable insights on why doctors get sued.  When comparing the respective bedside manner of each group, Dr. Levinson reported no difference in the amount or quality of information doctors gave their patients. For example, the never-sued doctors didn't provide more details about medication or the patient's condition.  The difference was entirely in how they talked to their patients. (See also:  Why Doctors Get Sued.)'  Dr. Levinson adds that, although her colleagues are often more focused on their medicine than on their communication skills, she knows consumers can certainly relate to the need to enhance doctor-patient communication:

At cocktail parties, when I tell other doctors what I do, they're not really interested. But if I tell patients, they ALL have a story to tell.

Read more on this study from the Annals of Internal Medicine or from the report about it published in the Boston Globe.

More Blog Posts by Carolyn Thomas

author bio

Carolyn Thomas is a heart attack survivor and a 2008 graduate of the annual WomenHeart Science and Leadership Symposium at Mayo Clinic in Rochester, Minnesota. She was also named by “Our Bodies Ourselves” of Boston in 2009 as one of 20 inductees from seven countries acknowledged as “Women’s Health Heroes” for community activism in promoting women’s health. This post originally appeared on her Heart Sisters blog. She also writes at The Ethical Nag: Marketing Ethics for the Easily Swayed and you can follow her on Twitter @HeartSisters or @TheEthicalNag.


Tags for this article:
Heart Disease   Inside Healthcare   Carolyn Thomas   Communicate with your Doctors  


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