Patient complaints may worsen defensive medicine

Doctors often have a communication disconnect with their patients.

A recent piece from the New York Times encapsulates the issue, citing a recent New England Journal of Medicine perspective.

According to oncologist Ethan Basch, “Direct reports from patients are rarely used during drug approval or in clinical trials. If patients’ comments are sought at all, they are usually filtered through doctors and nurses, who write their own impressions of what the patients are feeling.”

There are a variety of reasons for this. Some doctors feel they have a better sense of the patient’s symptoms than the patient himself. Biases can affect how doctors and nurses perceive symptoms. For instance, there is a “tendency to downgrade symptoms may be based on the doctor’s knowledge that a patient is in the early stages of an illness and could be much worse. Or the doctor may be making mental comparisons with other patients who are sicker.”

More interesting is how the threat of malpractice can be a factor: “Describing a problem in a chart creates a record that the doctor may have to act on. ‘There may be a defensive lack of documentation,’ [Dr. Basch] said.”

But does every patient complaint need to be acted upon? In the current liability environment, unfortunately, the answer may be yes. Woe to the physician who dismisses a symptom only to miss a life-threatening diagnosis.

Compound that with the lack of time most doctors have, it’s easy to see how there is a tendency to answer every patient symptom with a diagnostic test or referral. It’s another subtle, yet prevalent, variation of defensive medicine.

There’s no question that doctors need to better listen to patients.  That job would be made easier if the malpractice cloud that shrouds the interaction was cleared.


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