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Unmet expectations: Doctors, patients give each other mixed reviews

A new Consumer Reports survey shows that they disagree on key issues and offers suggestions on how to improve the relationship.

By Damon Adams — Posted Jan. 29, 2007

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Patients gripe that doctors keep them waiting for 30 minutes or more and don't spend enough time in the exam room. Doctors grumble that patients don't follow treatment and request unnecessary tests and prescriptions.

That's the word from a nationwide survey of 39,090 patients and 335 primary care physicians in the February Consumer Reports. The magazine best known for rating new cars and other products scrutinized the patient encounter, then used its findings to recommend ways to improve the doctor-patient relationship.

Based on the results, Consumer Reports told patients to bring limited and credible health information from the Internet to the doctor, prepare a short list of questions, speak frankly about symptoms, follow doctor order, and change physicians if unsatisfied.

The article also detailed differing perspectives of doctors and patients on drug ads, Internet information and adherence to treatment plans. For example, nearly all patients said they completely or mostly obeyed doctor's orders, but 59% of physicians said their patients often failed to stick to treatment plans.

The magazine admits that its survey of subscribers might not be representative of the population. Physicians agree but see the report as an opportunity to discuss what is right and wrong with the doctor-patient relationship and explore ways to make it a better union.

Scrape away the griping and grumbling and one thing is clear, physician leaders said. Better communication is essential to improve the doctor-patient relationship.

"If there's good communication between patients and doctors, then problems can be addressed as they arise. Physicians have to establish a climate of trust and safety where patients' concerns are heard in a nonjudgmental fashion," said internist and medical ethicist G. Caleb Alexander, MD, assistant professor of medicine at the University of Chicago.

In the Consumer Reports survey, conducted in 2006, patients said they were highly satisfied with their doctors and got better under their care. But one in four patients was annoyed by long wait times, and one in five fussed about being unable to schedule an appointment within a week.

Patients also said that about one in three doctors failed to discuss side effects of prescribed drugs, and two-thirds did not address costs of treatments and tests -- sentiments supported by previous research.

A study in the Sept. 25, 2006, Archives of Internal Medicine found that physicians often did not talk about adverse side effects with patients. Physicians discussed medication costs with patients about one-third of the time, said a study in the November 2006 issue of The American Journal of Managed Care.

No wonder patients often leave the office frustrated, experts said.

"Patients suffer from having low expectations of their doctors because they're used to waiting and being treated as less important than the doctor," said internist Gail Gazelle, MD, an assistant clinical professor of medicine at Harvard Medical School and president of MD Can Help, a medical advocacy service for patients. "The doctor needs to always remember that the patient is a human being who should be treated with the same respect that the physician expects."

Physicians see bothersome behavior

What bugged doctors about patients, according to Consumer Reports? Not following treatment, not discussing symptoms, and asking for unnecessary tests and prescriptions.

Four in 10 doctors said patients often showed up poorly informed because of bad information culled from the Internet. Seventy-eight percent said patients occasionally asked them to prescribe drugs they saw advertised on television. Doctors said the health care system favors drug and health insurance companies more than primary care physicians and patients.

That sounds about right to doctors outside the survey pool.

"What bothers doctors most is when [patients] say they're [following treatment] and they're not really doing it. Often, we're just not being straightforward with each other," said internist Robert Arnold, MD, director of the University of Pittsburgh Institute for Doctor-Patient Communication.

Texas neurologist Randolph W. Evans, MD, saw some common complaints in the Consumer Reports survey and his poll of colleagues at the Texas Neurological Society's February 2006 conference. The 78 respondents in his survey said the most bothersome patient behaviors were not showing up or being late for appointments, verbally abusing staff, not complying with treatment, and not knowing medications being taken.

"A huge complaint was unnecessary phone calls. People call up at 3 in the morning and wake the doctor up and ask for sleeping pills," said Dr. Evans, clinical professor at Baylor College of Medicine in Houston.

What are patients and doctors to do to improve relations?

Physicians should remember that each patient has different expectations of doctors. Some patients want a paternalistic physician who tells them what to do while others prefer a doctor who allows for patient input, said Mack Lipkin, MD, who has researched communication patterns of primary care physicians and is director of the New York University School of Medicine Division of Primary Care.

New York City cardiologist Nieca Goldberg, MD, said doctors should be more willing to review the Internet material patients bring. "This information is here to stay, so we need to adapt to it," said Dr. Goldberg, chief of women's cardiac care at Lenox Hill Hospital.

She said patients should bring questions to doctors, and she asks her patients up front if they have questions, because it gives her insight into their mind-set.

Patient satisfaction surveys are one way to spot problems. The Cancer Treatment Centers of America in Philadelphia asks patients about visits and how it can do a better job, said Steven Standiford, MD, the center's chief of surgery. The happiest patients are the ones whose doctors value them as people and make encounters a teamwork experience, he said.

At his family practice in Tupelo, Miss., AMA Immediate Past President J. Edward Hill, MD, uses an electronic health system to enhance patient visits. With the click of a computer key, he prints out drug information and gives it to patients when he prescribes medication. Test results are sent to his computer, where they stay on his desktop until he notifies patients.

But technology won't make much difference if doctors and patients don't build a foundation of trust. "People are reluctant to be as open and trusting as they should be," Dr. Hill said, "and that's bad for their health."

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ADDITIONAL INFORMATION

Dissatisfaction

A Consumer Reports survey found that doctors and patients don't always see eye-to-eye. Here are some of the most common gripes:

What bugs patients about doctors
Kept me waiting 30 minutes or longer 24%
Could not schedule an appointment within a week 19%
Spent too little time with me 9%
Didn't get test results promptly 7%
Didn't respond to my calls promptly 6%
What bugs doctors about patients
Don't follow prescribed treatment 59%
Wait too long before making appointment 41%
Are reluctant to discuss symptoms 32%
Request unnecessary tests 31%
Request unnecessary prescriptions 28%

Source: Consumer Reports, February

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When things go right

Consumer Reports asked readers what they liked about their doctors. Here is the percentage of patients who rated their doctor "excellent" in the following areas:

Treats me with respect 77%
Listens to me with patience and understanding 67%
Seems to care about my emotional well-being 64%
Has encouraged me to ask questions 57%
Has made efforts to get to know me as a person 42%

Source: Consumer Reports, February

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