Messages often muddled in doctor-patient talks

NEW YORK Mon Jan 12, 2009 2:51pm EST

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NEW YORK (Reuters Health) - Doctor-patient communication can be fraught with misunderstanding, a new study confirms.

After 74 meetings between people with severe arthritis of the knee and physicians to discuss treatment, nearly 20 percent of the time, the patient and physician disagreed on whether or not the doctor had recommended knee replacement surgery.

"That's pretty telling. That's disturbing," Dr. Richard L. Street, Jr., of Texas A&M University in College Station told Reuters Health. Often, Street noted, patients and physicians simply take it for granted that they understand one another, but the findings make it clear this isn't always the case.

When deciding to go through with a procedure like knee replacement, which carries risks and also requires extensive rehabilitation, it's crucial that the patient and doctor be "on the same page," Street said. To investigate this, Street and his team recruited 74 patients with knee osteoarthritis that was severe enough to warrant total knee replacement. The patients met with one of 27 health care providers to talk about their care.

There was "modest to poor" agreement between the doctors and the patients after the meetings on how severe the patient's osteoarthritis was and on the risks and benefits of knee replacement, the researchers found. Usually, physicians thought the patient's osteoarthritis was less severe than the patient did.

In 13 cases, or 18 percent, the doctor and patient disagreed on whether the physician had recommended knee replacement surgery.

They also found that doctors typically considered complications of the surgery to be less of a concern than patients did.

The stronger the agreement between patient and doctor on the benefits of knee replacement, the more satisfied the patients were and the greater their intention of following the doctor's recommendations.

Miscommunication isn't limited to discussions about this type of surgery, but is everywhere in health care, Street said in an interview. For patients, he added, the findings have two key implications. "It's real important for patients to share their viewpoints," he said. "If they have concerns they've got to be explicit about those, if they've got an opinion or preference they need to get that out on the table."

Also, Street added, patients should "check for understanding" by repeating back what the physician is telling them (for example, "So what you're telling me is ...").

The take-home message for doctors, Street added, is "don't assume anything. What they need to do is check for understanding themselves."

SOURCE: Arthritis & Rheumatism, January 15 2009.

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