The gap between doctors' and patients' perceptions
http://www.100md.com
《英国医生杂志》
1 BMJ Learning, BMA House, London WC1H 9JR kmwalsh@bmjgroup.com
During her husband's consultation Mrs Prior mentioned three symptoms of her own: itching, cystitis, and a rash.1 She mentioned them as a "by the way," and her general practitioner saw her and did some blood tests. Would you be so patient? Or would you ask her to come back? There is no right answer to this question but, reading between the lines, perhaps the primary purpose of the consultation was to discuss her problems. Respondents on bmj.com thought that this was common and that the reasons for it included not wanting to have to make a separate appointment or to wait and, in some countries, not wanting to have to pay. Maybe she thought her problems were trivial or maybe she was afraid that they were not and wanted to downplay them to herself and her husband and her doctor.
Whatever her reasons, the literature suggests that doctors could be better at finding out why patients come to see them. One study showed that in routine consultations 45% of patient's concerns are not elicited.2 In half of visits the doctor and the patient do not agree on the nature of the presenting problem.2 And doctors often assume that patients' first complaint is their chief one, but in fact the order in which patients present their problems is often unrelated to their clinical importance.3 These are all strong arguments for longer appointment times in primary care.
Readers were also asked what they would tell the patient about the results of her tests. The responses varied: most people said they would tell her that she had abnormal liver function and that she needed further investigations. Some said that they would tell her that she had septicaemia or a bug or something nasty. It is striking that nobody discussed how to tell her this news, how much information to give her, or how much she would be able to take in at this stressful time. Respondents were expansive about the differential diagnosis but clammed up when talking to the patient. Maybe it's not surprising then that, while most patients say they want more information than they receive, doctors vastly overestimate the time they spend on explanation and planning for the future.4 5
Competing interests: None declared.
References
Heathcote J. Abnormal liver function found after an unplanned consultation case outcome. BMJ 2004;329: 500.
Kurtz S, Silverman J, Draper J. Teaching and learning communication skills in medicine. Abingdon: Radcliffe Medical Press, 1998.
Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med 1984;101: 692-6.
Waitzkin H. Doctor-patient communication. Clinical implications of social scientific research. JAMA 1984;252: 2441-6.
Makoul G, Arntson P, Schofield T. Health promotion in primary care: physician-patient communication and decision making about prescription medications. Soc Sci Med 1995;41: 1241-54.(Kieran Walsh, editorial r)
During her husband's consultation Mrs Prior mentioned three symptoms of her own: itching, cystitis, and a rash.1 She mentioned them as a "by the way," and her general practitioner saw her and did some blood tests. Would you be so patient? Or would you ask her to come back? There is no right answer to this question but, reading between the lines, perhaps the primary purpose of the consultation was to discuss her problems. Respondents on bmj.com thought that this was common and that the reasons for it included not wanting to have to make a separate appointment or to wait and, in some countries, not wanting to have to pay. Maybe she thought her problems were trivial or maybe she was afraid that they were not and wanted to downplay them to herself and her husband and her doctor.
Whatever her reasons, the literature suggests that doctors could be better at finding out why patients come to see them. One study showed that in routine consultations 45% of patient's concerns are not elicited.2 In half of visits the doctor and the patient do not agree on the nature of the presenting problem.2 And doctors often assume that patients' first complaint is their chief one, but in fact the order in which patients present their problems is often unrelated to their clinical importance.3 These are all strong arguments for longer appointment times in primary care.
Readers were also asked what they would tell the patient about the results of her tests. The responses varied: most people said they would tell her that she had abnormal liver function and that she needed further investigations. Some said that they would tell her that she had septicaemia or a bug or something nasty. It is striking that nobody discussed how to tell her this news, how much information to give her, or how much she would be able to take in at this stressful time. Respondents were expansive about the differential diagnosis but clammed up when talking to the patient. Maybe it's not surprising then that, while most patients say they want more information than they receive, doctors vastly overestimate the time they spend on explanation and planning for the future.4 5
Competing interests: None declared.
References
Heathcote J. Abnormal liver function found after an unplanned consultation case outcome. BMJ 2004;329: 500.
Kurtz S, Silverman J, Draper J. Teaching and learning communication skills in medicine. Abingdon: Radcliffe Medical Press, 1998.
Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med 1984;101: 692-6.
Waitzkin H. Doctor-patient communication. Clinical implications of social scientific research. JAMA 1984;252: 2441-6.
Makoul G, Arntson P, Schofield T. Health promotion in primary care: physician-patient communication and decision making about prescription medications. Soc Sci Med 1995;41: 1241-54.(Kieran Walsh, editorial r)