How Truthful are Patients with Their Physicians?
Abstract & Commentary
By Frank W. Ling, MD, Clinical Professor, Departments of Obstetrics and Gynecology, Vanderbilt University School of Medicine, and Meharry Medical College, Nashville, is Associate Editor for OB/GYN Clinical Alert.
Dr. Ling reports no financial relationships relevant to this field of study.
Synopsis: More than 70% of patients treated for depression acknowledged withholding the truth from their treating physician.
Source: Sawada N, et al. How successful are physicians in eliciting the truth from their patients? A large-scale internet survey from patients' perspectives. J Clin Psychiatry 2012;73:311-317.
Patients who received treatment for depression within a year were identified in a Japanese database of more than 323,000 patients. The investigators asked 2354 patients to complete a questionnaire on depression with a specific focus on patient-physician relationships. Only 2020 patients successfully completed the survey, with 70.2% reporting that they had withheld the truth from their physician. There was significant correlation with being female, younger age, and having a lower degree of satisfaction with communication with their physician. Information about "daily activities" and "symptoms" was withheld in 69.2% and 52.6% of patients, respectively. Female patients were more likely to be untruthful regarding "adherence to prescribed medication" and "figures such as body temperature and weight." Almost 32% of patients had discontinued treatment without consulting the physician, which correlated more with being female, young, and unsatisfied with their communication with their physician.
Commentary
There is a single, hugely significant message embedded in this article. In my opinion, what each of us should take away from this article is that we should not assume facts or history, but instead should explicitly ask our patients about what we want to know. This may take more time if we do it regularly, but if improved patient compliance and outcomes are achieved, it is well worth the investment of effort.
These data are relevant to us on many levels. Specifically, even though the study population includes both men and women, the most significant findings are in women, i.e., patients for whom we care. Also, even though the study focuses on only patients treated for depression, we know that depression is more common in women than in men overall, and that specific circumstances that are closely associated with depression and depressive symptoms are unique to women, e.g., premenstrual dysphoric disorder, postpartum depression, menopause, and chronic pain. The findings also suggest that a younger age is a contributing factor to withholding the truth, which is of particular importance to us because of the obstetric population that we serve.
Several reasons that patients gave for acting as they did reminded me of patients in my own practice. Any practitioner in the women's health arena has heard comments that were cited in the article for noncompliance with medications, such as "...my symptoms did not improve even though I received treatment," "...my symptoms got better," "I was afraid of getting hooked on prescribed medications," or " I experienced side effects." We should all pay close attention to the troubling finding that the second most common reason for discontinuing medication was "I did not get along well with my physician." Since this is not something that a patient is likely to tell us directly, it appears that we need to remain vigilant in all patients. Since it is the patient who is "ill," the responsibility of maximizing the doctor-patient alliance falls squarely on our shoulders.
There are certainly obvious aspects of the study that leave it vulnerable to criticism, e.g., it involves only Japanese patients, it includes only depressed patients, the patients essentially self-selected themselves into the study, etc. Nevertheless, the core message remains a strong one: If you suspect noncompliance in your patients, you just might be correct.
Patients who received treatment for depression within a year were identified in a Japanese database of more than 323,000 patients. The investigators asked 2354 patients to complete a questionnaire on depression with a specific focus on patient-physician relationships.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content