Common Issues for Patients

There are many reasons why patients as well as physicians are frustrated with health care. Numerous articles have been and continue to be published citing the reasons why patients may not get ideal treatment of their medical condition.
 
One major factor in patient’s not being satisfied with their health care is the failure to establish a relationship of shared decision making with their doctor. Shared decision making is when the patient and their family have become informed partners in their care and understand the uncertainties in medicine. The lack of establishing such a relationship between the physician and patient can result in:

 

1.  The medical problem not being adequately addressed

74% of errors in diagnosis are due to “premature diagnostic anchoring” where only one diagnosis is listed by the physician

7% of clinically significant test results in ambulatory care are never communicated to the patient

2.   A lack of understanding by both patients and doctors as to why medical tests and/or treatments are being performed

68% of lab tests ordered do not alter patient management

36% of adults in the U.S. do not understand what the doctor is telling them, independent of their education or background. This is referred to as “health illiteracy”.

Lack of adherence by patients to recommended treatment plans costs the U.S. economy an estimated $106-236 billion annually

3.  Poor follow-up and lack of a plan

40-80% of medical information provided by health care practioners is forgotten immediately after the office visit

Time constraints can drive ordering of tests without a well thought out plan that engages the patient/family in their care

 
Literature cited:
  • Bar MS. The need to test the patient centered medical home. JAMA. 2008 Aug 20; 300(7):834-5.
  • Britten N, Stevenson FA, Barry CA, Barber N, Bradley CP. Misunderstandings in prescribing decisions in general practice: qualitative study. BMJ 2000; 320: 484-8.
  • Casalino LP, Dunham D, Chin MH, et al. Frequency of failure to inform patients of clinically significant outpatient test results. Arch Intern Med. 2009 Jun 22; 169(12):1123-9.
  • Fisher ES. Building a medical neighborhood for the medical home. N Engl J Med. 2008 Sep 18; 359(12):1202-5.
  • Graber ML, Nancy Franklin N, Gordon R. Diagnostic Error in Internal Medicine. Arch Intern Med. 2005; 165:1493-1499.
  • Kessels RP. Patients’ memory for medical information. J R Soc Med. 2003 May; 96(5):219-22.
  • Kravitz RL, Melnikow J. Engaging patients in medical decision making. BMJ. 2001 Sep 15; 323(7313):584-5.
  • O’Connor AM et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2009 Jul 8; (3)
  • Miyakis S, Karamanof G, Liontos M, et al. Factors contributing to inappropriate ordering of tests in an academic medical department and the effect of an educational feedback strategy. Postgrad Med J. 2006 Dec; 82(974):823-9.
  • Schattner A, Bronstein A, Jellin N. Information and shared decision-making are top patients’ priorities. BMC Health Serv Res. 2006 Feb 28; 6:21.
  • Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW, Jordan J. The impact of patient-centered care on outcomes. J Fam Pract. 2000 Sep; 49(9):796-804.
  • Vernon JA et al (2007). Low Health Literacy: Implications for National Health Policy. Available at http://npsf.org/askme3/pdfs/Case_Report_10_07.pdf accessed: 5.5.10