Tell Me Where It Hurts

By Buzz McClain
Special to The Washington Post
Tuesday, February 6, 2007

Most patients think their doctors treat them respectfully, listen to them patiently and care about their emotional well-being. That's the finding of a recent poll of 39,000 patients and 335 primary care doctors. Still, the survey found plenty of complaints on both ends of the stethoscope.

Among patients' biggest grumbles, found the survey conducted by the nonprofit Consumer Reports National Research Center and published in the February issue of Consumer Reports: doctors' failure to divulge the cost of medications or office visits (cited by two-thirds of respondents); failure to mention medication side effects (cited by almost one-third); doctors who couldn't see them within a week (19 percent); and doctors who don't return tests results promptly (7 percent).

For their part, doctors took umbrage with patients for not "following their prescribed treatment," waiting too long to make an appointment and being reluctant to discuss their symptoms.

Some of the survey findings appeared to contain ironies. For example, most patients said they "completely" follow the doctor's advice -- on filling prescriptions, taking medications on time and completing the course of meds. But most doctors -- 59 percent -- noted patients' noncompliance as their main complaint.

Failure to follow advice "is a reality, that's for sure," said Edward Hill, immediate past president of the American Medical Association and a family physician in Tupelo, Miss. "It's a personality issue many times. I tell them to take the medication as prescribed, and as soon as they feel better they quit taking it, even for chronic diseases like high blood pressure and diabetes," for which treatment isn't effective unless medication is continued.

But Hill admitted that "sometimes we in medicine don't communicate quite as well as we should." The survey confirms that miscommunication is rife on both sides.

A third of the doctors complained that many of their patients are not specific about their symptoms, which handicaps the doctor when it comes to treating them. The study suggests patients may be embarrassed when describing what ails them, so they withhold details that would assist the treatment. They may also neglect to mention details because they don't think they're important.

"I call those embarrassing medical topics the Five P's," said Vicki Rackner, a former Seattle surgeon and the founder of Medical Bridges, a company that encourages employers to have their workers take a more assertive role in health care: "peeing, pooping, paying, procreating and psychosomatizing -- physical pain brought on by emotional causes." She called poor communication "one of the basic barriers to quality medical care."

Patients who said they first chose their doctor on the basis of friend or family recommendations were more likely to have a positive experience than those who chose the doctor because of his or her location or participation in a health plan.

"You add a link of trust," Rackner said, just as with a personal relationship.

"As seen on TV" may work to sell Ginsu knives but appears less dependable for medication. Nearly 80 percent of doctors reported being urged by patients to prescribe them medications they saw advertised in TV ads; 40 percent of the doctors said such advertising "was not in the public interest."

The survey confirmed many patients' reliance on the Internet for self-education. Forty percent of patients surveyed said they went to the Internet for information about their pain and possible cures. About the same share of doctors -- 41 percent -- said their patients were misinformed by what they read on the Web. "I keep a little card in my pocket of what I think are reputable Web sites they can go to," Hill said. "For instance, the National Institutes of Health Web site, or the CDC [Centers for Disease Control and Prevention] Web site or [official] specialists' Web sites."

On the subject of divulging the cost of health care, Rackner said doctors need to do more.

"When I was first starting out, I wondered what it cost to take out a gallbladder," she said. "One surgeon told me, 'You can't ask that question; it violates antitrust laws. We could be accused of price fixing.' There's a conspiracy of secrecy about cost. That's a big problem that's fortunately changing. Money might be the ultimate taboo [in health care], even more so than sex."

As for patient face time, more than half of the surveyed doctors said that had been shortened in the past five years, during which time they had had to expand their practices to meet their target income. And more than half also said they saw too many patients in one day to give effective treatment.

Consumer Reports acknowledged that the survey may not represent the views of the general population, since the respondents were composed of subscribers to the magazine. The physicians who were polled, however, came from a random sample drawn from a national list of doctors.

Only 9 percent of patient respondents cited limited face time with doctors as a major complaint. No survey question was asked about the wait time at the office. ยท

Buzz McClain is a Washington area freelance writer.

© 2007 The Washington Post Company