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M
ind Body Health
 

Doctors and Patients: Not on the Same Wavelength

© David S. Sobel MD

The following is one in an ongoing series of columns entitled Mind Body Health by David S. Sobel MD. View all columns in series
Imagine having a health evaluation and several weeks later being "quizzed" on which medical diagnoses and risk factors your doctor explained. How many will you correctly recall? If you are like the majority of patients, probably less than half.

A new study from the Mayo Clinic found that patients frequently forget what their doctors tell them. Following a general medical evaluation, 566 patients received advice from their doctor about health problems and cardiac risk factors that were uncovered in the examination. When these patients were asked several weeks later at home, they did not remember 68% of the health problems discussed by their doctor, including 54% of the most important diagnoses-colorectal polyps, obesity, hypothyroidism, osteoarthritis, and tobacco abuse. Fortunately, patients were most likely to recall a new diagnosis of a major health problem.

The reasons for the "disconnect" between what physicians say and what patients hear and remember:

  • Doctors do a poor job of explaining and use medical terms patients don't understand.
  • Patients experience information overload.
  • Patients listen "selectively," screening out certain information.
  • Patients experience "denial" of certain problems such as smoking and obesity.
  • Patients' perception of the seriousness of a health problem may differ from that of their physicians.
Both patients and physicians need to take action to improve this communication. Patients must become more involved in decisions, especially the important aspect of defining their problems. Physicians can provide, and patients can request, written lists or summaries of major diagnoses and problems. Patients can make notes and at the end of the visit clarify their understanding of what action steps they and the physician will take. Good communication, a vital ingredient for a healthy doctor-patient partnership, requires effort.

Rx: Be Clear on Diagnoses and Follow-up Plans

Repeat these four key points to your doctor at the end of your visit.
1.The diagnosis, the nature and cause of your symptoms or what might be causing your symptoms and the prognosis, the expected duration, course, and outcome of the condition

2. Treatment recommendations and instructions

3. The follow-up plan - Should you return for a visit? If so, when and why? Should you phone for test results? Are there any danger signs you should watch for and report back to your physician?

4. What actions you are going to take? - This confirms that you clearly understand the most important information. Repeating also gives the doctor a chance to correct any misunderstanding. If you don't understand or remember something the physician said, admit that you need to go over it again. You might say, for example, "I'm pretty sure you told me this before, but I'm not sure I understand."

For More Information:
Scheitel SM et al: Patient-physician agreement about medical diagnoses and cardiovascular risk factors in the ambulatory general medical exam. Mayo Clinic Proceedings 1996;71:1131-7.


Excerpted with permission from the Quarterly Newsletter, Mind/Body Health Newsletter. For subscription information call 1-(800)-222-4745 or visit the Institute for the Study of Human Knowledge website.

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About The Author
David S. Sobel, M.D., M.P.H., is a practicing physician in adult medicine and Medical Director of Patient Education and Health Promotion for Kaiser Permanente Northern California. He is physician lead for the national initiative in Self-Care and Shared Decision-Making for Kaiser Permanente. He is coauthor of Living a Healthy Life with Chronic Conditions, The Healing Brain,......more
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