1 How frequently do doctors misdiagnose patients? While research has demonstrated that most of the time a medical diagnosis is on point, the answer is probably higher than patients expect and certainly higher than doctors realize. In a Supplement to the issue of The American Journal of Medicine, a collection of articles and commentaries sheds light on the causes underlying misdiagnoses and demonstrates a nontrivial rate of diagnostic error that ranges from 5% in the perceptual specialties (pathology, radiology, dermatology) up to 10% to 15% in many other fields. Physician overconfidence and a lack of feedback following a diagnosis are two important contributors to the problem. 2 Who prescribes antibiotics inappropriately? Foreign, extra-busy and older MDs When it comes to inappropriate antibiotic prescribing, all physicians are not created equal. Canadian study found that the doctors most likely to prescribe antibiotics in error are those who’ve been in practice longer, see more patients or trained outside Canada or the US. The study found that international medical graduates are a shocking 78% more likely than Canadian- and American-trained MDs to give antibiotics inappropriately. That correlation, however, doesn’t appear to be explained by poor knowledge. Some countries, Spain foremost among them, simply have more liberal attitudes about antibiotics. The study also found that doctors who see an average of 34 or more patients per day are 20-27% more likely to give antibiotics where they’re not appropriate. The research also showed that for each year a physician is in practice, their rate of inappropriate prescribing increases 4%. 3 Doctors’ choice of prescriptions are often influenced by their patients Physicians’ choice of prescriptions are often influenced by patients, with patient experience with specific drugs playing a strong role, according to the Management Insights feature in Management Science journal. Researchers found that patients play an important role in prescription decisions, but that their influence diminishes when the doctor is a specialist, and that they have no influence in situations where specialists are treating patients with severe symptoms. 4 Free drug samples influence prescribing When a pharmaceutical company puts drug samples into the hands of doctors as a form of marketing, how does it influence their prescribing behavior? One in three doctors agrees that free drug samples influence prescribing, finds a small but representative US survey published in theJournal of Medical Ethics. 5 Patients treated with respect more likely to follow medical advice Attention doctors: Want patients to follow your advice? Treat them with dignity. In a national survey of more than 5,000 Americans, those who said they were treated with dignity during their last medical encounter were more likely to report higher levels of satisfaction with their care, adhere to therapy and get preventive services. 6 Doctor-Patient communication has a real impact on health Good doctor-patient communication makes a difference not only in patient satisfaction but in patient outcomes including resolution of chronic headaches, changes in emotional states, lower blood sugar values in diabetics, improved blood pressure readings in hypertensives, and other important health indicators (Communication Interventions Make A Difference in Conversations Between Physicians and Patients: A Systematic Review of the Evidence PubMed). 7 Most patients want to shake hands with their physicians When it comes to the doctor-patient relationship, patients have some pretty specific ideas about how they want their doctors to greet them when they first meet. The researchers from Northwestern University Feinberg School of Medicine, Chicago, interviewed 415 U.S. adults by telephone about how they want their doctors to greet them. The survey results show that most patients want their doctors to shake their hands, greet them by name, and introduce themselves using their first and last name when they first meet. The survey found that, among patients: 78.1% wanted physicians to shake their hands, while 18.1% did not 50.4% wanted their first names used during greetings, 17.3% preferred their last name and 23.6% favored the physician using both first and last names 56.4% wanted physicians to introduce themselves using first and last names, 32.5% expected physicians to use their last name, and 7.2% would like physicians to use their first name only 8 7 things patients expect from doctors If you ever felt like your doctor was trying to push you out of the examination room before you had a chance to explain your condition, you are not alone. A new study from the Mayo Clinic shows that most people agree on what makes a good doctor and it definitely isn’t one who hurries through a visit. A doctor’s people skills can affect a patient’s emotional response and recovery very positively or very negatively, research shows. Based on the study, which surveyed 192 patients, the authors concluded that an ‘ideal’ physician should be: Confident Empathetic Humane Personal Forthright Respectful Thorough 9 Surgeons are taller and better looking than other doctors Doctors at the University of Barcelona Hospital noticed that the tallest and most handsome male students were more likely to go for surgery, and the shortest (and perhaps not so good looking) ones were more likely to become physicians. So they decided to test the theory that, on average, surgeons are taller and better looking than physicians. The results show that, on average, senior male surgeons are significantly taller and better looking than senior male physicians. They also show that film stars who play doctors are significantly better looking than real surgeons and physicians (Phenotypic differences between male physicians, surgeons, and film stars: comparative study, BMJ). 10 Patients often receive incomplete drug instructions Physicians prescribing new medication often do not say to patients important details, such as potential side effects, how long or how often to take or the specific name of the drug, according to the study. This study demonstrated that doctors communicated an average of 3.1 of the 5 essential elements, indicating that only 62% of the necessary information was conveyed. Physicians used the specific name for 74% of new prescriptions, explained the purpose for 87% and discussed adverse effects for 35%. 34% of the encounters included instructions on how long to take the drug, 55% on the number of tablets to take and 58% on the frequency or timing of use. 11 Disclosure of medical errors: there is a gap between physicians’ attitudes and their real-world experiences admitting such errors Physicians may say they would disclose a medical error, but how many actually do? From a survey of faculty physicians, resident physicians and medical students, researchers from the University of Iowa found that while nearly all respondents indicated that they would disclose a hypothetical error, less than half reported having disclosed an actual minor or major medical error. 12 The highest rate of “Off-label” prescriptions accounts for Antidepressants, Anticonvulsants, and Antipsychotics The researchers from theUniversity of Georgiaexamined data on drugs prescribed to 107,000 Georgia Medicaid recipients in 2001. They found that 75% of antidepressant recipients, 80% of anticonvulsant recipients and 64% of antipsychotic recipients received at least one of these medications off-label. Many patients have no idea that this goes on and just assume that the physician is writing a prescription for their indication. Off-label use of central nervous system drugs can account from anywhere from 25 to 80% of a drug’s annual sales. In the case of the Neurontin (gabapentin) nearly all – 98% – of patients received the drug off label in 2001. 13 Seven medical myths even doctors believe Even physicians sometimes believe medical myths contradicted by scientific evidence. In a study published in the British Medical Journal, Indiana University School of Medicine researchers explored seven commonly held medical beliefs: 1. People should drink at least eight glasses of water a day 2. We use only 10% of our brains 3. Hair and fingernails continue to grow after death 4. Shaving hair causes it to grow back faster, darker, or coarser 5. Reading in dim light ruins your eyesight 6. Eating turkey makes people especially drowsy 7. Mobile phones create considerable electromagnetic interference in hospitals Despite their popularity, all of these medical beliefs range from unproved to untrue. 14 Majority of U.S. doctors believe religion is beneficial for patients’ health More than half of physicians believe that religion and spirituality have a significant influence on patients’ health, according to a report in the Archives of Internal Medicine. The study also found that 76 percent of physicians believe that religion and spirituality helps patients cope, 74 percent believe that it gives patients a positive state of mind and 55 percent report that it provides emotional and practical support through religious community. Source
