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Communication gap seen between patients, doctors

NEW YORK (Reuters Health) - What doctors think they are telling hospital patients, and what those patients actually hear, may be very different, a small study suggests.

The findings, from a study of 89 patients at one U.S. hospital, add to research showing that doctors and patients are often not on the same page when discussing diagnoses and treatment.

In interviews with the patients on the day of their discharge, researchers found that only 18 percent even knew the name of the main physician in charge of their hospital care. Meanwhile, just 57 percent left the hospital knowing what their diagnosis was.

In contrast, two-thirds of the 43 physicians interviewed thought their patients knew their name, and 77 percent believed their patients were aware of their diagnosis.

Drs. Douglas P. Olson and Donna M. Windish of Yale University School of Medicine in New Haven, Connecticut, report the results in the Archives of Internal Medicine.

The finding that many patients were unsure of their diagnosis or their doctor’s name may sound surprising, but it is not new, according to Olson. Past studies have found that the majority of hospital patients cannot name their main physician, and frequently cannot name their medical problem.

However, the current study also shows that many doctors mistakenly believe their patients know more than they do.

“What’s new here is the discrepancy between doctors and patients,” Olson told Reuters Health. “Patients aren’t really getting the take-home message.”

The communication gaps go beyond names and diagnoses, the study found. Of patients in this study who were prescribed a new medication during their hospital stay, one-quarter said their doctor never told them about it. And very few -- 10 percent -- said their doctor discussed the drug’s potential side effects with them.

In contrast, all physicians in the study said they at least sometimes told patients about any new prescriptions, and 81 percent said they described the possible side effects at least some of the time.

In recent years, the medical community has increasingly focused on improving doctor-patient communication. In residency programs at academic hospitals, for instance, doctors-in-training are taught to include patients in discussions rather than talking amongst themselves in front of patients, Olson pointed out.

“But there’s still a disconnect,” he said, adding that even when patients say they understand, that often turns out not to be the case.

One explanation, according to Olson, may be that many hospitalized patients are elderly and have complex medical problems -- not just one diagnosis, but several co-existing health conditions -- and the information they receive during their stay “could understandably be overwhelming.”

And compared with 30 or 40 years ago, Olson noted, patients’ hospital stays are now typically much shorter; that leaves them with less time to absorb and fully understand information about their condition and any treatment changes.

One potential way to address the communication gaps would be to give patients and families written information, in addition to spoken explanations, during the hospital stay -- and not only at discharge, Olson said.

“It’s important for us to take a step back and see how some system changes might improve communication,” he said.

Steps patients and their family members can take include writing down any questions as they come up so they can raise them with the doctor later, according to Olson.

Family involvement is important, he noted, particularly for older patients with more complex medical problems and multiple medications.

“How is my life going to be different when I leave the hospital?” is a good general question that patients can ask their doctors, Olson recommends. It can help start a discussion about a range of concerns, including any lifestyle adjustments and medication changes that need to be made, he said.

Olson also advised that patients lacking a primary care doctor get the number of someone at the hospital whom they can call with any questions after they are discharged.

SOURCE: link.reuters.com/mun34n Archives of Internal Medicine, August 9/23, 2010.

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