PHYSICIANS: Fail to Communicate With Patients
General practitioners and surgeons regularly fail to foster fully informed participation by their patients in clinical decision- making, despite a current emphasis in the medical community on improving patient-physician communication, a study published in this week's issue of the Journal of the American Medical Association finds. The authors warn that the results raise concerns about quality of care, and an editorial in the same issue urges physicians to find ways of involving patients in decision-making regardless of hurdles.
Informed Decisions Rare
Researchers at the University of Washington evaluated audio tapes of 1,057 office visits to 59 primary care physicians and 65 surgeons, during which 3,552 clinical decisions -- such as medication choices or follow-up appointments -- were made. They found that the physician engaged the patient in a complete discussion of the decision -- including an attempt to elicit the patient's preferences -- only 9% of the time. Basic decisions were more likely to be completely informed, while almost none of the intermediate or complex decisions were completely informed.
Gap Between Ethics and Practice
The study notes that lack of patient involvement in making clinical decisions may negatively impact acceptance of and adherence to treatment programs, in addition to harming the relationship between physician and patient. It calls for physicians to view informed decision-making as "an ethical obligation toward mutual decision-making by fostering understanding," rather than a legal obligation to disclose all the relevant facts about a treatment (Braddock et al., 12/22). The accompanying editorial argues that, while most physicians claim to support the goal of informed decision-making, they have not "embraced the concept in day-to-day office practice." It suggests that time constraints may be one obstacle to more fruitful discussions, and challenges physicians to overcome such barriers, perhaps through more effective use of educational materials that would explain basic concepts and treatment alternatives, leaving more time to discuss patients' desires (Barry, 12/22).