Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

Is It Bad Patient Behavior Or Poor Doctor-Patient Communication?

It seem like everyone these days is focused on changing some aspect of patient health behavior. You know — getting patients to get a mammogram or PSA test, exercise more, take medications as prescribed, or simply becoming more engaged in their healthcare. If only we could change unhealthy patient health behaviors, the world would be a better place.
 
I agree with the sentiment, but I think that patients and their health behavior often get a “bad rap” from healthcare professionals. I would even go so far as to say that much (not all) of what we attribute to poor patient behavior is more correctly attributable to ineffective doctor communications with patients.

In my last post I talked about the link between strong physician advocacy, e.g., I recommend, and desirable health outcomes, i.e., patients getting more preventive screening.
 
Here’s what I mean. Mammography studies have consistently shown that screening mammograms rates would be much high if more physicians “strongly recommended” that women get screened, e.g., “I recommend” you get a mammogram. In studies where physicians advocated for screening, mammography screening rates were always higher compared to physicians that did not advocate for them. The same phenomenon can be found in studies dealing with exercise, weight loss, colorectal cancer screening, HVP immunization, and patient participation in clinical trials.

In cases where physicians unequivocally recommended to patients that they do XYZ, patients were much more likely to do it — or at least they were much more likely to try. I am not naive enough to believe that an unequivocal recommendation from a physician is a “cure all” for the most recalcitrant patients. Factors such as level of patient trust in the physician and patient’s agreement with the physician’s diagnosis are mediating factors. Depression and fatigue from dealing with chronic conditions also play a role. But the evidence clearly suggests that a good many patients probably would respond positively to a strong recommendation from their physician.
 
Here’s an anecdotal experience describe by a physician comment on my last blog post:

“I agree that doctor-patient communication is critically important. My 50 year-old best friend shuns doctors, but told me he is getting a colonoscopy because his doctor strongly recommended it.”

Here’s the basis for my thinking. Many patients operate on the principle that if my doctor thinks something is important they will tell me. On this point patients can be quite literal. I have seen studies in which obese patients do not see themselves as “obese.” Their self-perception is validated every time their doctor fails to tell the patient that they have a serious weight problem and that they need to lose 20 pounds in no uncertain terms. If I have such a big weight problems, why hasn’t my doctor said anything?

Think back to your recent trips to the doctor. If you are like me, you may be hard pressed to think of a single instance in which your physicians ever said the words “I recommend” to you.

The only such instance I can recall was when my wife’s oncologist (stage 4 lung cancer) said: “I recommend that you start the chemo treatment immediately — tomorrow wouldn’t be too soon.” My wife did what her doctor recommended and she is alive today some six years later.

REFERENCES:

Carroll, J., et al. “Clinician-Patient Communication About Physical Activity in an Underserved Population.” Journal of the American Board of Family Medicine. 2008;21:118–127.

Taylor, V., et al. “Colorectal Cancer Screening Among African Americans: The Importance of Physician Recommendation.” Journal National Medical Association. 2003;95:806-812.

Brown, T., et al. “Predictors of Cardiac Rehabilitation Referral in Coronary Artery Disease Patients.” Journal of the American College of Cardiology. Vo. 54, 2009.

Albrecht, T., et al. “Influence of Clinical Communication on Patients’ Decision.” Clinical Oncology. 26:2666-2673. 2008.

*This blog post was originally published at Mind The Gap*


You may also like these posts

Read comments »


Comments are closed.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »