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ScienceDaily are reporting: Hurried Doctor Visits May Leave Patients Feeling Forgetful
Quote:
Have you ever been whisked through a doctor's visit, and afterward were unable to remember what the doctor said? A University of Rochester Medical Center study disclosed that doctors don't often take the steps necessary to help patients recall medical instructions.
The study, published online in this month's Journal of General Internal Medicine, investigated how frequently physicians repeat themselves, write down information, summarize instructions or take other steps to help patients remember the doctor's advice. The results suggest that doctors do not use these tools effectively or consistently. In fact, not one of the 49 doctors who took part in the study summarized their treatment recommendations.
"It's common for patients to forget half of what they're told in a medical visit," said the study's lead author, Jordan Silberman, a second-year University of Rochester medical student. "Obviously, this is cause for concern. As noted by the British researcher Philip Ley, 'if the patient cannot remember what he is supposed to do, he is extremely unlikely to do it.' No matter how effective a treatment is, it can be rendered useless by poor recall."
Researchers sent unannounced standardized patients (actors trained for this study) into primary care physician practices across Rochester, N.Y., with hidden recording devices. The actors complained of typical heartburn symptoms. Researchers then coded the recordings to determine how often doctors reinforced their instructions in some way.
Only about a third of the physicians wrote down instructions for patients. About half of the physicians repeated their recommendations, but some only repeated about 10 percent of the information.
Very few of the doctors made sure the patient understood by asking him or her to repeat it back to the doctor -- a technique cited in research literature as one of the best ways to help patients recall medical advice. For example, Silberman said, the doctor might say, "We've talked about a lot of things today and I want to make sure you understand everything. Can you explain to me what you're going to do when you get home?"
Lack of time may be the biggest obstacle for doctors, researchers believe. The next step is to develop a new approach to improve patient recall that can be applied in today's busy practices, and then to study the techniques in the context of what is feasible for doctors.
BACKGROUND Effective treatments can be rendered useless by poor patient recall of treatment instructions. Studies suggest that patients forget a great deal of important information and that recall can be increased through recall-promoting behaviors (RPBs) like repetition or summarization.
OBJECTIVE To assess how frequently RPBs are used in primary care, and to reveal how they might be applied more effectively.
DESIGN Recordings of 49 unannounced standardized patient (SP) visits were obtained using hidden audiorecorders. All SPs presented with typical gastroesophageal reflux disease symptoms. Transcripts were coded for treatment recommendations and RPBs.
PARTICIPANTS Forty-nine primary care physicians.
RESULTS Of 1,140 RPBs, 53.7% were repetitions, 28.2% were communication of the rationale for a treatment, 11.7% were categorizations of treatments (i.e., stating that a treatment could be placed into a treatment category, such as medication-related or lifestyle-related categories), and 3.8% were emphasis of a recommendation’s importance. Physicians varied substantially in their use of most RPBs, although no physicians summarized or asked patients to restate recommendations. The number of RPBs was positively correlated with visit length.
CONCLUSIONS Primary care physicians apply most RPBs inconsistently, do not utilize several RPBs that are particularly helpful, and may use RPBs inefficiently. Simple principles guiding RPB use may help physicians apply these communication tools more effectively.
I recall a similar project from ~15 yrs ago. It was done in New York as a gynaecologist's office. Each consultation was audio recorded (patient did not know). As the patient left the receptionist gave each patient a white rose. Waiting down the street in each direction were the researchers looking for people with white roses. They waited down the road to give time for what happened during the consult to sink in. They then asked the patient about the advice given and what they were told about there problem. They then compared that to the audio of what they were actually told.
I do not recall the exact results, but they were horrific. The patients had either forgot or got wrong >50% of what they were told!
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Also, this kind of research does raise ethical issues:
Quote:
Originally Posted by NewsBot
Recordings of 49 unannounced standardized patient (SP) visits were obtained using hidden audiorecorders.
Did the physician consent to this? I hope they did! - even if it was a blanket consent and they did not know which would be the 'standardised" patient. If consent was not obtained, then that is problematic ethically (I have not read the full paper); if they did give consent, then the Dr's behaviour would have been altered as they knew about the project (informed consent) --> invalidates research.
Quote:
Originally Posted by Craig Payne
Each consultation was audio recorded (patient did not know).
There would have been issues here about the ethics of deception and not knowing about the recording. I assume that they would have had to give consent after for the researchers to listen to the tape. The problem is that many ethics committees today (maybe not when this research would have been done) may not permit it today.....BUT, if the patient knew they were being recorded for research purposes (informed consent), then this would affect their recall and behaviours --> invalidates research.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Dr visits leave patients forgetful
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