Do patients always get all of the information they need from their physician?

The following is a guest post by Harold DeMonaco, MS, a member of our editorial team, and Director of the Innovation Support Center at the Massachusetts General Hospital.  A graduate of the Massachusetts College of Pharmacy and Allied Health Sciences he holds a bachelors degree in pharmacy and a masters degree in therapeutics.  He has a keen interest in the innovation process in medicine and organizational behavior related to change.

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If anyone continues to wonder about the need for patients to take a more active and collaborative role in their care, a recent article in Health Affairs should give them pause.  Investigators at the Mongan Institute for Health Policy at the Massachusetts General Hospital surveyed 1891 physicians across the country to assess how, “…how widely physicians endorse and follow these principles (as defined by the Charter for Medical Professionalism) in communicating with patients.”

The good news is that most of the physicians who responded believed in the principles and followed them at least in terms of fully informing patients about the risks and benefits of a particular treatment or intervention.  The majority also thought physicians should never disclose confidential patient information to unauthorized people.  That’s good because if they did they would be violating HIPAA rules regarding protected health information.

But, the survey also provided some rather disturbing information.

• About a third of physicians responding, “…did not completely agree with disclosing serious medical errors to patients.”
• About 20%, “did not completely agree that physicians should never tell a patient something untrue.”
• Nearly 40%, “…did not completely agree that they should disclose their financial relationships with drug and device companies to patients.”
• About 10% acknowledged that they had told a patient something that was untrue in the previous year.

I have worked with some dedicated physicians over my career.  Some of this may not be as terrible as it sounds.  Not being totally truthful to a dying pediatric patient may be in the patient’s best interest for example.  Surveys have a nasty habit of making complex issues binary and don’t allow for provisos or stipulations.  So, I guess you could cut the medical community some slack in at least one of the responses.

But some of the responses are rather distressing and speak to a significant problem in the physician-patient relationship and in the willingness of some to embrace open and honest communication with their patients.

Errors unfortunately happen in all walks of life, including medicine.  The vast majority are systems related and not necessarily tied to any one individual.  Try as we might to reduce their likelihood and impact, they will occur.  Most healthcare institutions work hard to understand what went wrong and to try to identify ways on making certain that it won’t happen again.  While I have no data, I suspect all institutions have gotten the message that non-disclosure is not only inappropriate but also rather foolish in the long run.  I know of no healthcare institution that fosters not telling the patient.  Apparently that message has not filtered down to a significant minority of physicians.

As story reviewers for HealthNewsReview.org, we sometimes get heat from reporters on our insistence that interviewee’s potential conflicts of interest be made transparent.  We believe that it is an important piece of information to place a story and the information provided by that individual into context.  The same should hold true in the physician-patient interaction.  Information related to a potential conflict of interest in a physician’s prescribing of a drug or decision to use one company’s medical device over another should be part of the discussion.  I would personally want to know if my physician was prescribing a drug based in some measure on a financial relationship with the manufacturer.  The fact that 40% of the respondents to the survey do not think this information should be available to patients is mind boggling. It looks like shared decision making has not quite become main stream.  This survey drives home its necessity.

In the interest of full disclosure and transparency, I am currently employed by the Massachusetts General Hospital and know one of the investigators personally.

ADDENDUM:

On the Croakey blog, Melissa Sweet writes about the “interesting juxtaposition of two sets of research findings about doctors’ disclosures of their financial relationships with pharmaceutical companies.”