Liar, Liar, Doc’s on Fire!

Think your doctor is telling you the truth?  After we’ve literally bared our bodies and souls to them, you’d think they would give us the truth, the whole truth and nothing but the truth.

So it’s perhaps surprising to learn that a survey of U.S. physicians found that “some patients might not receive complete and accurate information.”  The findings were published in Health Affairs – a leading journal of health policy thought and research that explores issues of current concern in both domestic and international spheres.

The survey included approximately 1900 physicians specializing in primary care (internal medicine, family practice, and pediatrics) as well as specialists in cardiology, general surgery, psychiatry, and anesthesiology.  These physicians responded to a questionnaire exploring their attitudes about communication with patients.

Among the findings:

The vast majority of physicians completely agreed that physicians should fully inform patients about the risks and benefits of interventions and should never disclose confidential information to unauthorized persons.

However:

  • Over 10% admitted to having told an adult patient or child’s guardian “something that was not true” in the past year
  • One-third of physicians did not completely agree with disclosing serious medical errors to patients
  • Nearly 20% said they had not “fully disclosed a mistake to patients” because of fear of being sued
  • About two thirds said they should disclose financial relationships with drug and device companies to their patients, the other third only partially agreed or disagreed.

These findings have raised concerns that some patients might not receive complete and accurate information from their physicians, and doubts about whether patient-centered care is broadly possible without more widespread physician endorsement of the core communication principles of openness and honesty with patients.

Do you want your doctor to tell you the truth, no matter what?  Is an omission of information ever acceptable?  Can a little sugar-coating be good?  Let us know what you think.

Kiss and Tell?

About 300 years ago, the English author Alexander Pope famously wrote “To err is human, to forgive is divine.

New research from the University of Illinois, Chicago concurs.  According to a study published in the November issue of Medical Care, people who believe their doctor or hospital would inform them if a medical error occurred are far more forgiving than those who doubt their health care provider would disclose the error.

A medical error is defined as a preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete  diagnosis or treatment of a disease, injury or other ailment. Medical errors are one of the nation’s leading causes of death and injury and cost the US approximately $10 billion annually.  The Institute of Medicine estimates that as many as 300,000 patients are victims of medical errors, of which maybe as many as 200,000 people die.

In the new study, researchers surveyed a representative sample of Illinois residents regarding medical errors. About 40% of participants either had personal experience with medical errors, or had a close friend or family member who had been affected by an error.

Based on a hypothetical scenario, just 10% of survey respondents believed their physicians would be “very likely” to tell them if a medical error occurred. Yet, only a quarter said they would file a medical malpractice lawsuit if they were told about a medical error.

Respondents who trusted their doctor to disclose medical errors were no more (or less) likely to say they would sue. This was so even in a scenario where the health care provider offered to correct the problem through free additional medical treatment, and possibly a financial settlement.

However, people who trusted their health care provider to inform them about the error were more forgiving. Of the respondents who were most confident that their doctor or hospital would disclose the error, more than 60 percent said they would still recommend the provider, despite the error.

In contrast, only 30% of those who were skeptical about disclosure would continue to recommend the doctor or hospital.

The researchers found that although disclosure of medical errors is strongly preferred by patients, the most common policy is to “deny and defend” when errors occur because providers fear that it will trigger lawsuits and jeopardize their reputation.

The results show that patients perceived beliefs have a significant impact on their behavior. Patients who trust their providers to disclose errors may be no less likely to sue, but appear more likely to forgive. Conversely, patients who are most skeptical about disclosure may view their health care provider with “suspicion and frustration.”

Clearly when it comes to medical screw-ups, honesty is the best policy.

One test too many?

How’s this for a dichotomy?  During the same week we learned that America is $13 trillion in debt, a new study reported that over 90% of US doctors knowingly order more tests and procedures than are medically necessary.

No surprise then that the United States spends more than any other industrialized country on healthcare expenses.  A staggering $2 trillion annually to be exact.

The new survey by Mount Sinai School of Medicine, published in Archives of Internal Medicine questioned 2,416 physicians. 91% of respondents believe that concerns over malpractice lawsuits result in them practicing “defensive medicine.”

About $60 billion is spent annually on defensive medicine and many physicians feel they are vulnerable to malpractice lawsuits even when they practice competently within the standard of care,” said Tara Bishop, MD, co-author of the study.

The majority of physicians (90.7%) also stated that for them to decrease the ordering of unnecessary medical tests, better protections against unwarranted malpractice suits are needed.

Word on Health could not agree more.  At a time when the healthcare system is in such crisis that hospitals nationwide are reporting major drug shortages, we should not be forcing physicians to waste money to protect themselves from malpractice concerns. Not only are we exposing patients to unnecessary, and often invasive, procedures, this crippling fear of litigation is surely impacting health care reform efforts.

Time for tort reform?  Let us know what you think .