What Doctors Wish Their Patients Knew - Special report
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Special report
What
Doctors
Wish
Their
Patients
Knew
ma rch 2011 w w w.C o n su m e r R e p o rt s. o rg 1
June, 2012
Dear Employee -
Consumer Reports is excited to work with the National Business Group on Health
and your employer to bring you some of the most important health stories we have
recently published. For 75 years, Consumer Reports has published information that
helps consumers make better choices about the things they buy. We think it’s time
that consumers approach health care the same way.
The first article focused on hospital infections, especially the most deadly kind:
bloodstream infections caused by central-line intravenous (IV) catheters. The second
examined tests and treatments related to heart disease that do not work as well as many of us think. The
third focused on dangerous supplements, many advertised as health promoting but in fact risky.
Our latest article in this series, based on a comprehensive survey of patients and doctors, focuses on the
relationship between them. An enduring relationship that is professional, respectful, and caring is the
goal. Physicians most want patients to follow their advice. But challenges are frequent. Many patients
now go online to look for medical information. Physicians are often skeptical of much of that
information. And some physicians access drug-sales staff for information. Patients are rightfully
concerned about that source. Doctors acknowledge that some situations pose challenges, especially pain
control. And of course the world is changing. More and more medical-record information is electronic
and is therefore more easily available to all. Both have concerns about how the length and thoroughness
of office visits.
Here at Consumer Reports we take the same approach to health care as we do to other kinds of products
and services. Start with our own independent experts. Provide perspectives from trusted sources
especially consumers. Present meaningful comparisons along with examples from real people. Urge an
assertive but constructive approach. Give consumers simple tips to avoid problems and improve results.
We look forward to hearing any thoughts you have about this article or others you will see in the future.
Contact us by sending an e-mail to HealthImpact@cr.consumer.org.
Sincerely,
John Santa MD MPH
Director, Consumer Reports Health Ratings Center
Consumer Reports
Headquarters
101 Truman Avenue
Yonkers, New York 10703-1057
914-378-2000
2 co n sum er r ep ort s ma rc h 2 0 1 1
cover story
Lede start here caption continued
What doctors wish
their patients knew
Surprising results from our survey of 660 primary-care physicians
T
he typical office visit with a patients could do to get the most out of
Inside primary-care doctor lasts about their relationship with their own doctors.
20 minutes—and is sometimes Some highlights of the surveys:
Finding Dr. Right
Page 3 even shorter. Getting the most • Doctors and patients alike put a high
out of those precious minutes requires value on courtesy and professionalism.
Your medical home navigating a complex relationship and • Patients aren’t taking full advantage of
Page 5 addressing a number of often complicated strategies that doctors think are helpful,
and sometimes emotionally charged, such as taking notes during their visits.
medical issues. Despite those constraints, • Not knowing much up front about a
three-quarters of the 49,007 Consumer doctor’s personality or treatment style was
Reports subscribers we surveyed said they a real obstacle for patients in search of a
were highly satisfied with their doctors. good match.
But they still had complaints ranging Together those survey results help cre-
I l l u s t r at i o n s by r i c h a r d m i a
from the irritating, such as having to sit ate a road map toward a more productive
too long in the waiting room, to the sub- relationship with someone who, after all,
stantive, such as ineffective treatments. should be your most important health-
We also surveyed 660 primary-care care professional.
physicians who had a lot to say about their “A primary-care doctor should be your
professional challenges—and about what partner in overall health, not just someone
ma rch 2011 w w w.C o n su m e r R e p o rt s. o rg 3
special report what your doctor wishes you knew
you go to for minor problems or a referral to Respect is a two-way street. Patients
specialty care,” said Kevin Grumbach, M.D., who gave their doctors high marks for
professor and chair of the department of “professionalism” were more likely to be
family and community medicine at the Uni- highly satisfied. We measured profession-
versity of California at San Francisco. alism by looking at whether patients
The Consumer Reports National Re- thought they had been treated respectful-
search Center conducted the subscriber ly and whether their doctor seemed tech-
survey in 2009 (our readers may not be rep- nically competent, took their medical
resentative of the U.S. population as a 1 Survey says history into account, listened with pa-
whole). The online poll of a national sam- tience and understanding, and spent
61% 8%
ple of primary-care physicians was con- enough time with them. The more of
ducted in September 2010. those standards their doctors met, the
higher the patients’ overall satisfaction.
Physicians take the long view Patients who said Doctors who said
But being courteous doesn’t mean you
Doctors said that forming a long-term rela- they researched that Internet have to be passive (though you can if you
tionship with a primary-care physician is health information research by wish; 37 percent of patients we surveyed
the most important thing a patient can do on the Internet to patients was preferred to trust their doctor’s judgment
to obtain better medical care, with 76 per- help with their very helpful. on treatment decisions). Most doctors said
cent saying it would help “very much.” medical care. that it was “somewhat” or “very” helpful
“That continuity is really undervalued,” for patients to ask them questions and
said Jessie Gruman, Ph.D., president of the Research seems to back up Gruman’s occasionally question their recommenda-
Center for Advancing Health, a patient- experience. It suggests that patients who tions; a mere 4 percent thought those
advocacy group in Washington, D.C. frequently switch doctors have more strategies were downright unhelpful.
Gruman said that because of a health health problems and spend more on care
history that included three separate bouts than patients who have a consistent rela- Please take your medicine
of cancer, her longtime primary-care tionship with a single physician. Noncompliance with advice or treatment
doctor urged her to tell him promptly recommendations was the top complaint
about any new symptom, no matter how Respect is a two-way street doctors had about their patients. Most of
minor, that lasted more than two days. Being respectful and courteous toward the doctors we surveyed said it affected
“I hate the idea that my health is your physician was the No. 2 thing doctors their ability to provide optimal care:
fragile,” she said. “He was able to capture said patients could do to get better care; 37 percent said it did so “a lot.”
my imagination and get me to act in a 61 percent said it would help “very much.” But compliance these days can be a lot
way that was consistent with my inter- But 70 percent said that since they had more complicated than just remembering
ests.” When new symptoms appeared, started practicing medicine, respect and to take a pill, patient advocate Gruman
Gruman told her doctor. Four days later, appreciation from patients had gotten “a said. Hospitals are sending patients home
she was diagnosed with stomach cancer. little” or “much” worse. with long lists of self-care chores. Drug
Finding Dr. Right
It’s sad but true that it’s easier to find reliable find-a-doctor), that will include information on specific health condition, ask how much
information about cars and washing physician quality, including patient outcomes, experience that doctor has with it. And be
machines than it is about doctors. While that continuity, and coordination of care, efficiency, open about other concerns you have. “It’s a
is starting to change—Consumer Reports and safety. But the full site won’t make its little bit like dating,” said Jessie Gruman,
now works with the Society of Thoracic appearance until around 2015 at the earliest. Ph.D., a patient advocate. “You really want
Surgeons, for example, to rate heart-surgery Until then, use these tried-and-true this person to be responsive to a range of
groups (go to ConsumerReports.org and strategies to find a doctor: things, not just one aspect of your health.”
search for “heart surgery ratings”)—it’s still Ask people. Doctors we surveyed ranked Break up if it isn’t working. “Your
hard to get detailed, quality data on getting a recommendation from family or doctor is a service provider,” Gruman said.
individual doctors, especially primary-care friends as the most valuable method for “You wouldn’t have a plumber back who was
doctors. Yet 31 percent of the patients we choosing a physician. Next came referrals from disrespectful to you or left a mess.”
polled wished that they had more other doctors. Reasons to dump your doctor might
information when choosing a doctor. Ask questions. The more that patients include a bad bedside manner, inability to
Sure, some websites have basic we surveyed knew about their doctors, the communicate openly with you, an
information such as a doctor’s medical school more satisfied they were. That held true for appointment calendar that’s always full or
and board certification, and whether the factual information, such as hospital disorganized, an unhelpful staff, or a
practice accepts new patients. But none of affiliation and office hours, and especially for perpetually backed-up waiting room.
that information has much to do with a information such as the doctor’s personality Talk to your doctor about your concerns,
doctor’s quality. and professional style. and if nothing changes, consider finding
The health-reform law called for a public Audition the doctor. Use your first another physician. Don’t forget to have your
website, Physician Compare (www.medicare.gov/ appointment as an audition. If you have a medical records transferred.
4 con s um er r ep ort s m a rc h 2 0 1 1
and lifestyle regimens allow those with alternative treatments. as good as it usually is,” Gruman said.
chronic conditions to live longer, healthi- Our survey confirms that advice. Pa- “We don’t remember as well as we usually
er lives but can be difficult to manage or, tients who gave their doctors high marks do.” Taking notes, making sure you un-
in some cases, for patients to afford. for prescribing effective treatments also derstand the doctor’s instructions, and
Compliance doesn’t necessarily mean rated their doctors more favorably for im- taking somebody with you to pay atten-
following your doctor’s instructions slav- proving their understanding of the condi- tion can compensate, she said.
ishly, said Ronald Epstein, M.D., director tion; their ability to recognize symptoms
of the Center for Communication and Dis- requiring immediate attention; and mini- Research online, but carefully
parities Research at the University of Roch- mizing pain, discomfort, and disability The patients we surveyed were enthusias-
ester Medical Center in New York. Some caused by a condition. Patients were much tic online researchers; 61 percent reported
patients don’t follow treatment programs more satisfied if they trusted and had good that they had read about their condition
because they’re disorganized, he said, but personal rapport with their doctor. on the Internet. Doctors are not convinced
others might fail to comply because they’ve that online research is helpful, to put it
experienced serious side effects, don’t fully It helps to keep track yourself mildly. Almost half of physicians we sur-
understand what they’re supposed to do, Slowly but surely, primary-care doctors veyed said online research helps very little
or found the treatment wasn’t working. are switching over to electronic medical or not at all, and just 8 percent thought it
“Doctors need to make it safe for patients records. Thirty-seven percent told us they was very helpful.
to bring those things up,” he said. keep their records electronically only, Epstein said those findings don’t mean
Feel free to discuss, even debate, your you should close your browser, just that
doctor’s treatment plan while you’re still you should be a smart online researcher.
in the office. Then do your best to comply. “People have motivations for posting
If you’re having side effects, are unsure things on the Web, and some of those mo-
whether you’re following instructions tivations may not be helpful,” he said. For
properly, or experience new or recurrent instance, be wary of links that advertisers
symptoms, tell your doctor immediately. paid for or product sites designed to guide
you to a specific treatment.
Pain is tough to treat Instead of starting by entering the name
Doctors were harder on themselves than of your condition in a search-engine box,
patients were when it came to judging try going directly to a few reliable sites.
their ability to minimize the pain, dis- Our health site, ConsumerReportsHealth.
comfort, or disability caused by a condi- org, reviews impartial evidence and takes
tion. Only 37 percent of physicians thought no advertising (but some of its content is
they were “very” effective, though 60 per- 1 Survey says available only to paying subscribers). Gov-
cent more thought they were “somewhat” ernment sites are also a good place to
79% 37%
effective. But 79 percent of patients said start. Try these:
their doctor helped to minimize their pain • Centers for Disease Control and Pre-
or discomfort. vention (www.cdc.gov) for information on
Perhaps that’s because patients were Patients who said Doctors who said infectious disease, travel health, and
thinking only of their own conditions, doctors were able they were very preventive care.
whereas doctors were thinking of their to minimize their effective at • Food and Drug Administration (www.fda.
overall effectiveness with all of their pa- discomfort and alleviating pain gov) for drug information.
tients, including those with chronic con- pain caused by a and discomfort. • MedlinePlus (www.medlineplus.gov) for in-
ditions that are difficult to diagnose and condition. formation about conditions and diseases.
treat, such as fibromyalgia, immune dis- • National Cancer Institute (www.cancer.
orders, headaches, neck and back pain, gov) for cancer information.
and depression and anxiety. Our survey compared with just 24 percent who did so We also recommend high-quality aca-
found that patients with those conditions in 2007, during our last survey. demic treatment-center sites, such as those
were significantly more likely to com- But they want you to know that it still of the Mayo Clinic (www.mayoclinic.com) and
plain about ineffective treatments. Just pays to keep track of your medical history the Cleveland Clinic (www.clevelandclinic.org).
53 percent said their doctor helped to yourself. Eighty-nine percent said that If you find information online that you
minimize their pain or discomfort, and keeping an informal log of treatments, want to discuss with your doctor, print
only 31 percent were highly satisfied with drugs, changes in condition, notes from out only the relevant parts.
their doctor overall. previous doctor visits, and tests and pro-
“For patients with chronic conditions, cedures could be helpful. But only 33 per- Doctors are pressed for time
medical science can’t necessarily take cent of patients routinely did so. Likewise, Physicians said the sheer volume of insur-
away all of their suffering,” Epstein said. 80 percent of doctors thought taking a ance paperwork was No. 1 on the list of
“If you have a chronic condition, the im- friend or relative to your office visit could things that interfere with their ability to
portant thing is to find a doctor who lis- be beneficial, but only 28 percent of pa- provide optimal care. Next was financial
tens and involves you in decision making,” tients reported doing so. pressures that may force the majority of
and maybe even helps you sort through “When we’re sick our judgment is not primary-care providers in our survey to
ma rch 2011 w w w.C o n su m e r R e p o rt s. o rg 5special report what your doctor wishes you knew
work more than 50 hours a week seeing pharmaceutical salespeople.
more than 100 patients. Our patient survey suggests that’s a
But that doesn’t mean you should set- possible point of friction. Patients were
tle for hasty care. Patients who perceived less satisfied when they thought their
that their doctors cut corners were likely doctors relied too much on prescription
to be less satisfied. They were more likely drugs and were unwilling to consider non-
to report that their doctor was too quick to traditional or nondrug treatments. More
dismiss complaints or symptoms and were than one-quarter of patients indicated
more uncertain about what to do after an 1 Survey says some level of discomfort with their doc-
office visit. tors’ inclination to prescribe drugs. If you
28% 80%
To get the most out of your time, plan are concerned about your doctor’s rela-
ahead. Jot down a list of questions or con- tionship with pharmaceutical companies,
cerns you’d like to address during your ap- don’t hesitate to bring up the subject at
pointment, and prioritize them so you get your next visit.
Patients who said Doctors who said
to the most important ones first. If you
they brought a bringing someone
• Doctors are dubious about patients’
don’t have time to discuss everything, ask relative or friend to else to the office need to know about malpractice claims or
whether you can follow up by e-mail (that their office visit. visit was very or professional disciplinary actions. Forty-
is, if you can; only 9 percent of patients somewhat useful. seven percent said information about
said they e-mailed their doctor directly in whether the physician has been involved
the previous year). in a malpractice lawsuit was “of little val-
The doctors we surveyed are clearly ue.” Only 17 percent said that information
chafing against health-plan rules and re- They talk to drug salespeople about disciplinary actions by medical li-
strictions. Most said such red tape inter- The medical profession has not always censing boards was “very valuable.”
fered with the care they provided, and been the most transparent. The American It’s true that a malpractice suit can
42 percent said it did so “a lot.” Medical Association, for example, has befall any doctor and that disciplinary
You can’t do much as an individual fought to keep the Medicare payment re- actions from medical boards don’t neces-
about burdensome health-plan rules, cords of individual doctors confidential. sarily represent the doctor’s overall skill.
but you can avoid unwelcome surprises Here are a couple of things that primary- Still, disciplinary actions levied by medi-
by reading through and understanding care doctors might not want to tell you: cal boards can be for serious offenses, such
your health coverage. (Ask your human- • They talk to drug companies more than as substance abuse or criminal behavior,
resources department for help if you need you might realize. The majority of doctors that could affect your care. You might be
it.) For instance, inquire about your plan’s we surveyed said that pharmaceutical com- able to look up your doctor’s record online,
formulary, a preferred list of drugs for pany representatives contacted them more though the information that’s available
which it charges a lower co-pay. Under- than 10 times a month. Thirty-six percent differs by state. Find your state’s medical
stand what services your deductible applies were contacted more than 20 times a board at the Federation of State Medical
to, and find out what rules, if any, apply if month. On average doctors said they Boards website, at www.fsmb.org, or try your
you need to see a specialist. spend a few hours a week dealing with state health department.
Home sweet medical home
If you haven’t already heard the By keeping patients with chronic consumer-friendly features to
term “patient-centered medical home,” conditions healthier and out of look for:
chances are you will soon. hospitals and emergency rooms, • Can you get an urgent
“Our health system has become so and reducing wasteful and appointment within 24
fragmented that patients don’t know where duplicative services (such as hours?
to go for help and how to get it,” said Ronald multiple tests when only one is • Can you reach
Epstein, M.D., professor and director of the needed), Grumbach said, medical somebody in the practice
Center for Communication and Disparities home practices “are also showing by phone at night or on
Research at the University of Rochester lower costs.” weekends?
Medical Center in New York. The medical The health-reform law includes • Can you get your test
home, he said, is designed to “give patients incentives to create medical homes. results quickly via e-mail
someone who knows them as a person,” Several states are already paying doctors or telephone, or online?
guide them through the system, and make extra to oversee the health needs of Medicaid • If you have a chronic condition, is there a
sure their “needs are placed front and center.” recipients, and in some cases private insurers system for tracking how you’re doing?
In a medical home, the doctor becomes are participating in the experiments. • Does the practice include non-M.D. staff
an advocate for the patient, “not a gatekeeper Medicare is set to launch its own pilot members such as nutritionists or nurse-
that restricts access to services,” said Kevin program in coming years. practitioners to help you manage your
Grumbach, M.D., chair of the department of “Official” medical homes are still few medications or chronic condition?
family and community medicine at the and far between, but any practice can be • Does your primary-care doctor keep track
University of California at San Francisco. more patient-centered. Here are some of your treatment by specialists?
6 co n sum er r ep ort s m a rc h 2 0 1 1Consumer Reports professional. The information is meant to enhance communication with your doctor, not replace it.
James A. Guest, President, Consumer Reports Use of this report is also at your own risk. Consumer Reports cannot be liable for any loss, injury, or
Paige Amidon, Vice President, Health Programs other damage related to your use of this report. You should not make any changes in your medicines
Claudia Citarella, Senior Administrative Assistant without first consulting a physician. You should always consult a physician or other professional for
treatment and advice.
Health Ratings Center
John Santa, MD, M.P.H., Director, Health Ratings Center Errors and omissions
Doris Peter, Ph.D, Associate Director, Health Ratings Center We followed a rigorous editorial process to ensure that the information in this report and on the
Abbe Herzig, Ph.D, Statistical Program Leader, Health Ratings Center ConsumerReports.org website is accurate and describes generally accepted clinical practices. If we find,
Kristina Mycek, Ph.D, Associate Statistician, Health Ratings Center or are alerted to, an error, we will correct it as quickly as possible. However, Consumer Reports and its
Joel Keehn, Senior Editor, Health Ratings Center authors, editors, publishers, licensors, and any suppliers cannot be responsible for medical errors or
Kevin McCarthy, Associate Editor, Health Ratings Center omissions, or any consequences from the use of the information on this site.
Lisa Gill, Editor, Prescription Drugs Copyright notices
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Consumer Reports magazine or other Consumer Reports publications. source: What Doctors Wish Their Patients Knew, March 2011 report from Consumer Reports for members
of the National Business Group on Health.
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