written by Theresa Sullivan Barger
Doctors admit it’s sometimes hard to give patients the truth about their prognosis.
In fact, 55 percent of those who answered a nationwide survey said that they sometimes put a more positive spin on the facts. That’s counter to their profession’s widely endorsed standards of openness and honesty.
While about 66 percent of doctors agreed that they should disclose serious medical errors to patients, about a third didn’t think that they should, the survey shows.
And about 35 percent of responding doctors did not feel it was important to disclose to patients any financial relationships with drug and device companies, revealing a potential conflict when a new national disclosure law goes into effect next year.
The findings, reported in the February 2012 issue of Health Affairs, don’t bode well for health care that is truly “patient centered” and focused first and foremost on the needs of patients, says Dr. Lisa Iezzoni, lead author of the article and professor of medicine at the Harvard Medical School.
“It really is important for patients to have complete information about their prognoses if they’re going to make informed decisions,” says Iezzoni, director of the Mongan Institute for Health Policy at Massachusetts General Hospital in Boston. While doctors may be trying to spare patients, it would be better for patients if doctors “have a conversation with their patients about how they want to be told information.”
Iezzoni and colleagues surveyed 1,891 doctors nationwide in 2009 to find out if they followed the standards endorsed by more than 100 professional groups worldwide in the Charter On Medical Professionalism, which urges doctors to be open and honest with patients and to disclose medical errors promptly.
While the vast majority—89 percent—of doctors completely agreed that they should fully inform patients about the risks and benefits of treatment, when asked about their own behavior in the previous year, 11 percent of respondents said that they had told an adult patient or a child’s guardian something that was not true.
Dr. Rebecca Andrews, a primary care internist and professor at the University of Connecticut Health Center in Farmington, says she was trained at UConn in how to deliver news to patients. “You give the truth but not the over or under-truth” she says. The under-truth deprives the patient of enough information to make a decision and the over-truth means giving too much information at once, she says.
“I have a great relationship with a majority of my patients,” says Andrews. “Even when I’m giving them news that they don’t want to hear, my approach is to give it to them honestly, as gently as possible. If I’ve made an error, fix it and get back on track.”
“As much as I would like to be perfect, it’s not possible,” she continued. “There are mistakes that are made.” She says she prays not to make big mistakes and communicates honestly about what happened when something goes wrong. Andrews, 37, says she isn’t sure if it’s a generational thing or the fact that she comes from a family distrustful of doctors, but she gets the patient’s perspective.
In the survey, almost one-fifth of doctors said that they had not fully disclosed mistakes to patients for fear of being sued. In theory, two-thirds said they fully agreed they should disclose medical errors to patients, while 34 percent said they somewhat agreed or disagreed.
The survey also revealed among doctors in regions with the lowest third of malpractice claim rates, 68.9 percent completely agreed that doctors should fully disclose financial relationships with drug and device manufacturers to patients, compared with 60.9 percent of physicians in regions with the highest third of malpractice claims.
And the type of setting where a doctor practiced also resulted in different responses. More doctors, some 78 percent, practicing in universities or medical centers completely agreed with the need to report serious medical errors than doctors in solo or two-person practices, where 61 percent agreed.
The survey shows that women and minority doctors were more likely to be honest with their patients compared to white or Asian male doctors. Also, they were more likely to disclose financial relationships with companies.
About 35 percent of physicians did not fully support disclosing potential conflicts of interest with drug and device companies to patients. This finding is important, the authors wrote, given the passage of the Physician Payment Sunshine Act of 2009, which requires companies to begin reporting payments to physicians in excess of $10 by March 2013.
With so many doctors unwilling to disclose their relationships with drug companies or medical device companies, it would be very awkward for patients to ask their doctors whether they have a financial incentive to recommend a medication or treatment, according to Iezzoni.
Iezzoni suggests that patients should take note of posters or pamphlets in waiting rooms supplied by drug companies. And patients can start a conversation by asking doctors whether they’ve done research on a drug they’re prescribing, whether they’ve studied the drug or worked with the company that made it. “That might seem a little more neutral.”
The survey was mailed to primary care doctors practicing internal medicine, family medicine and pediatrics and to four types of specialists – cardiologists, general surgeons, psychiatrists and anesthesiologists.
Out of the 500 randomly selected doctors in each specialty, the survey’s authors identified 2,938 eligible participants, 1,891 of whom completed the survey for a 64.4 percent response rate. Most respondents were male and white or Asian and had practiced medicine for at least 20 years.
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