Wednesday, August 8, 2018

Wisdom Wednesday: Clinicians Rarely Ask for Patients’ Input, Often Interrupt

During consultations, clinicians rarely ask patients to explain the reasons for their visit, a recent study published online July 2 in the Journal of General Internal Medicine has shown.

“The patient’s agenda was elicited in 36% of the clinical encounters,” writes Naykky Singh Ospina, MD, from the University of Florida, and colleagues. And, “among those in which the agenda was elicited, patients were interrupted seven out of ten times, with a median time to interruption of 11 seconds.”

According to the authors, patient-centered decision-making is a key feature of quality healthcare. In particular, identifying and understanding the patient’s agenda for the visit both improves and facilitates patient-clinician communication, they emphasize.

My Take:
The remainder of the article was devoted to a statistical analysis of the methods used to analyze these videotaped clinician-patient encounters.

I was taught, and still believe, that 80% of a good diagnosis is a detailed history. I often tell my patients who are not forthcoming during consult that without hearing their story I might as well be a vet. Of note, this article was written by Dr. Nicola M Parry, a veterinarian.

In theory, the consult guides your examination and combination of these two elements leads to confirmatory testing. Unfortunately, modern medicine works in reverse. They run a lot of tests and hope to find a diagnosis. Studies indicate that 80% of medical costs incurred by a patient are for diagnostic testing rather than treatment.

Patient-centered decision-making is also an integral part of evidence based medicine. Most physicians operate as if evidence based medicine is solely based on double-blind, placebo controlled studies. In fact, these studies do account for a third of an evidence based practice. However, patient preference is an equal third in this equation with clinical experience filling in the final third of the pie.

A few weeks ago, I placed a patient on herbal thyroid support based on her history and my exam findings. She called me his week, slightly panicked, after she had laboratory testing showing her TSH was well above medical norms. The high thyroid stimulating hormone (TSH) just confirmed what a good history and exam had already identified.

Laboratory testing is best utilized for confirmation of a suspected health issue. However, I do also recommend yearly testing as “casting a wide net” to look for possible evolving health issues, especially metabolic syndrome.

Bottom Line:
Please share your health concerns and symptoms with your physicians. If they fail to listen to you, find another physician.

Source: August 5, 2018 National Institutes of Health

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