June 26, 2008 Have you ever been whisked through a doctor's visit, and afterward were unable to remember what the doctor said? A University of Rochester Medical Center study disclosed that doctors don't often take the steps necessary to help patients recall medical instructions.
The study, published online in this month's Journal of General Internal Medicine, investigated how frequently physicians repeat themselves, write down information, summarize instructions or take other steps to help patients remember the doctor's advice. The results suggest that doctors do not use these tools effectively or consistently. In fact, not one of the 49 doctors who took part in the study summarized their treatment recommendations.
"It's common for patients to forget half of what they're told in a medical visit," said the study's lead author, Jordan Silberman, a second-year University of Rochester medical student. "Obviously, this is cause for concern. As noted by the British researcher Philip Ley, 'if the patient cannot remember what he is supposed to do, he is extremely unlikely to do it.' No matter how effective a treatment is, it can be rendered useless by poor recall."
Researchers sent unannounced standardized patients (actors trained for this study) into primary care physician practices across Rochester, N.Y., with hidden recording devices. The actors complained of typical heartburn symptoms. Researchers then coded the recordings to determine how often doctors reinforced their instructions in some way.
Only about a third of the physicians wrote down instructions for patients. About half of the physicians repeated their recommendations, but some only repeated about 10 percent of the information.
Very few of the doctors made sure the patient understood by asking him or her to repeat it back to the doctor -- a technique cited in research literature as one of the best ways to help patients recall medical advice. For example, Silberman said, the doctor might say, "We've talked about a lot of things today and I want to make sure you understand everything. Can you explain to me what you're going to do when you get home?"
Lack of time may be the biggest obstacle for doctors, researchers believe. The next step is to develop a new approach to improve patient recall that can be applied in today's busy practices, and then to study the techniques in the context of what is feasible for doctors.
The Agency for Healthcare Research and Quality funded the study, which was conducted at the Rochester Center to Improve Communication in Health Care, part of the URMC Department of Family Medicine. Co-authors include: Aleksey Tentler, a recent URMC graduate, Rajeev Ramgopal, a research coordinator at the VA Pittsburgh Healthcare System, and Ronald Epstein, M.D., URMC professor of Family Medicine and Psychiatry.
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