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Understanding Treatment: The Communication Disconnect Between Doctors And Patients

Over the long week­end I caught up on some read­ing. One arti­cle* stands out. It’s on informed con­sent, and the stun­ning dis­con­nect between physi­cians’ and patients’ under­stand­ing of a procedure’s value.

The study, pub­lished in the Sept 7th Annals of Inter­nal Med­i­cine, used sur­vey meth­ods to eval­u­ate 153 car­di­ol­ogy patients’ under­stand­ing of the poten­tial ben­e­fit of per­cu­ta­neous coro­nary inter­ven­tion (PCI or angio­plasty). The inves­ti­ga­tors, at Baystate Med­ical Cen­ter in Mass­a­chu­setts, com­pared patients’ responses to those of car­di­ol­o­gists who obtained con­sent and who per­formed the pro­ce­dure. As out­lined in the article’s intro­duc­tion, PCI reduces heart attacks in patients with acute coro­nary syn­drome — a more unsta­ble sit­u­a­tion than is chronic sta­ble angina, in which case PCI relieves pain and improves qual­ity of life but has no ben­e­fit in terms of recur­rent myocar­dial infarc­tion (MI) or survival.

The main result was that, after dis­cussing the pro­ce­dure with a car­di­ol­o­gist and sign­ing the form, 88 percent of the patients, who almost all had chronic sta­ble angina, believed that PCI would reduce their per­sonal risk for hav­ing a heart attack. Only 17 percent of the car­di­ol­o­gists, who com­pleted sur­veys about these par­tic­u­lar patients and the poten­tial ben­e­fit of PCI for patients fac­ing sim­i­lar sce­nar­ios, indi­cated that PCI would reduce the like­li­hood of MI.

This strik­ing dif­fer­ence in patients’ and doc­tors’ per­cep­tions is all the more sig­nif­i­cant because 96 percent of the patients “felt that they knew why they might undergo PCI, and more than half stated that they were actively involved in the decision-making.” Read more »

*This blog post was originally published at Medical Lessons*

Doctors, Hospitals, And The Yankees

Joe Boyd hated the Yankees. “Those damn Yankees. Why can’t we beat ‘em?” Then he got the opportunity to save his beloved Washington Senators by making a deal with the devil — giving up his soul in exchange for being transformed into “Shoeless Joe” to propel his team to win the World Series.

Interesting. I think a lot of doctors are making their deal with the devil. They are looking for a small gain in comparison to a long-term of misery. True — Joe Boyd made out in the end, but that will only happen if someone from Hollywood writes our script.

Here’s the problem: At the core of our problems with healthcare is the total lack of cohesive communication. Doctors have no idea what other doctors have done with a patient. Tests get ordered, medications get changed, procedures, hospitalizations, even surgeries are done without communication to other doctors who would benefit from this information. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Doctor-Patient Communication: Much Room For Improvement

In a surprising report from the Archives of Internal Medicine, we learn that most hospitalized patients (82 percent) could not accurately name the physician responsible for their care and almost half of the patients did not even know their diagnosis or why they were admitted.

If that isn’t enough, when the researchers queried the physicians, 67 percent thought the patients knew their name and 77 percent of doctors thought the patients “understood their diagnoses at least somewhat well.” I would call that a pretty significant communication gap.

Ninety percent of the patients said they received a new medication and didn’t know the side effects. Although 98 percent of physicians thought they discussed their patients’ fears and anxieties with them, only 54 percent of patients thought they did. Read more »

*This blog post was originally published at ACP Internist*

Pay Patients To Take Their Medicine?

The New York Times reported recently on efforts by providers and payers to increase patient medication adherence through the use financial incentives paid to patients. The article cited the use of small financial payments (<$100), awarded via lotteries, to patients that take Warfarin –- an anti-blood clotting medication.

There is certainly nothing wrong with financial incentives. Incentives have been proven successful in changing selected provider (quality and safety improvement) and patient behavior (stop smoking, weight loss and taking health risk surveys). But paying patients to take their medication is different. Actually, the evidence suggests that it is a just plain stupid idea for a whole lot of reasons. Read more »

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

Does Your Family Have A “Technology Gap?”

Older Woman and LaptopDo you have a technology participation gap in your family? We do. In fact, most families do somewhere.

For us, we have a few older relatives who firmly believe that technology is for “the younger generation.” What’s interesting is that some of these people are not that old — at least not “old” as I define it.

One relative, for example, was a working woman in her younger days. Retired now, she never bought into any technology past the 1970s! Beyond the automobile, refrigerator, TV, radio, dishwasher, washer and drier, she has seen no need for anything else.

Although  she has grudgingly begun to use email and the Web, she has deemed herself  ”old” and refused to use a cell phone or any other “high-tech device.” Read more »

*This blog post was originally published at Dr. Gwenn Is In*

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…

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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…

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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…

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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…

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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…

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