Did the Doctor Mean What the Patient Heard?

When we were kids, birthday parties were a great time to play “telephone.” In this game, an adult whispered a short phrase or sentence to the first child in a circle. That child whispered it to the next, who turned and whispered it to her neighbor, and so it went.
If you had at least ten youngsters involved in this game, what the last child announced out loud was different, often hilariously different, from the original message.
Now that we are grown up, the results are far from hilarious. One of the most serious situations for miscommunication is between doctors and patients.
Almost everyone we know who has been diagnosed with cancer has told us that was virtually the only word they heard during that initial doctor visit. It is so frightening and emotionally shocking to hear “You have cancer” that it blocks out almost everything else the doctor might say.
As a result, if the doctor suggests a series of alternatives for treatment, the patient is unlikely to grasp them all. Balancing benefits against risks is virtually impossible until the emotional shock has worn off and the nuances can be analyzed objectively.
Another area rife with misunderstanding is our number one killer, heart disease. When a cardiologist shows a patient his angiogram depicting partially clogged coronary arteries, the patient is usually quick to agree to a procedure, even in the absence of symptoms. A million such interventions are performed each year.
Many are unnecessary. A study in the Annals of Internal Medicine (Sept. 7, 2010) reveals that doctors and patients are not on the same page when it comes to the benefit of stents in coronary arteries.
People with classic chest pain (angina) were signed up for angiography, which provides pictures of the arteries. Roughly 80 percent of the 153 patients thought that a stent would reduce their risk of dying from a heart attack. Most of the cardiologists knew that was not true. Stents can ease the pain of angina, but do not prevent heart attacks.
An editorial in the same journal points out that all the patients in the study had signed informed consent forms. Despite the name, however, they clearly had not been well informed about whether and how they would actually benefit from the procedure. This communication failure puts many patients at unnecessary risk of surgery and costs society hundreds of millions of dollars.
Health professionals have a legal and ethical responsibility to explain clearly the benefits and the risks of any treatment they offer. That includes medications. Any time a drug is prescribed, the provider must discuss the pros and cons and verify that the patient has truly understood what he is getting into.
Prescribers tend to be good salesmen for their interventions. Many healthy people believe that taking a statin drug such as Crestor or Lipitor will save their lives. Yet the data do not support that assumption for people without heart disease (Archives of Internal Medicine, June 28, 2010).
The best way to verify that the patient and physician are communicating clearly is to play the old telephone game. The doctor should ask the patient to “teach back” the main points to make sure that the message has not gotten mangled.