What I wish all my patients knew

June 25, 2011

The author reflects on a Consumer Reports article about doctors and patients.

Overall, I was pleased with what I read. Inside I found a four-page article derived from a survey of 660 primary care physicians. I am not one of the 660. The physicians' major points:

From here they composed a "road map toward a more productive relationship."

I do like their first point, which is that patients need to regard their primary care physicians as their partners in health. Certainly it is incumbent on physicians to live up to this trust, but daily I encounter patients who have squandered resources, health, or both by not observing this most basic tenant of our relationship; 76% of the physicians state that maintaining long-term continuity of care would help "very much."

Aside from wondering about the other 24%, I'm left to recall a patient I saw recently. In spite of being my patient for a decade, her family didn't contact me when she turned abruptly ill. Instead, they took her to an unaffiliated hospital where duplicative (unnecessary) tests were ordered and she was placed on medication to which she is allergic.

Shortly after that, I saw a patient who now has severe colitis because an urgent treatment clinic prescribed for him an unnecessary antibiotic. Although every provider and facility intends to deliver quality medical care, examples such as these ones are commonplace, and underscore how important it is for patients to participate in better healthcare decision-making. Also, CR correctly points out that patients who do not have a consistent relationship with a single physician actually spend more on care than those who do.

Accurately, the article brings both patient and physician to task over respect and common courtesy. Discourteous and disrespectful patients are, I suspect, oblivious to their behavior and its consequences. This should serve as a dire warning to patients, because 70% of physicians responded that patient courtesy has declined since they had begun practice.

In insightful commentary, CR notes that passivity is not constructive or desired. Unfortunately, CR only applied this sentiment to patients who don't question their doctor. Most of us can recollect physicians who have been too passive and allowed patients to persuade them into delivering unnecessary or wasteful care.

Nonadherence, the quagmire of primary care, received prominent mention in the article as well. This was quoted as the number one gripe of the physicians. Of course, it is incumbent on physicians to help patients navigate the oftentimes complicated instructions required to complete a treatment plan. In a useful retort, one physician pointed out that physicians need to foster an environment in which it is safe to bring up reasons for deviating from a recommended course of treatment.

In spite of electronic health records, 89% of physicians stated that they want their patients to keep a log of medications, symptom changes, testing, and other relevant information, but only one-third of patients state that they do so. This is a major disconnect not only between physician and patient, but I suspect between the patients and the reporting. I further suspect a significant number of these patients might claim that their dog ate their blood pressure diary, if challenged to produce it.

Our office provides free wallet cards that allow a patient to list allergies, contact numbers, and medications. These cards are so successful that hospital-owned practices that compete with us in our community have copied the cards almost identically. However, they are not so successful that patients can religiously produce them on request.