Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Don’t overwhelm patients with unnecessary detail

Peter Ubel, MD
Physician
December 10, 2012
446 Shares
Share
Tweet
Share

It is not an easy time to be a physician in the United States.  Attempt to order an expensive test for a patient and an insurance company is likely to second guess your decision.  Try upholding the bottom line for your medical practice and the government will probably start questioning whether you are overcharging for your services.  To make matters worse, even patients are getting into the act, with an increasing number of them embracing their role as “empowered patients” to remind you that it is they who are the decision makers of last resort, not their physicians.

But there is a simple way for physicians to reclaim at least this last bit of power, a straightforward method of reclaiming their role as the final word in medical decision making; they need to do such a thorough job of informing patients about their medical alternatives—going into unrelenting detail about each risk and benefit of each and every treatment alternative, sparing no medical detail no matter how inconsequential—until bewildered patients have no choice but to ask their doctor for advice.

In Critical Decisions, I relay a portion of a conversation between a hematologist and a patient with a very serious malignancy.  The lengthy conversation is a bewildering mix of medical jargon interwoven with complex statistics.  To provide you with just a little sample:

“So if you look at complete cytogenetic response rates in the chronic phase,” the hematologist explains, “it’s about 80%, and if you look at the accelerated phase, it’s about 15%.  So, the drug doesn’t work in advanced disease very well. If you look at patients who get a complete cytogenetic response as their best response in the Iris trial, their risk of ever progressing in the next 4 years, so about 48 months roughly, is about 8% overall.”

“That’s good,” the patient replied.

“Yeah.  So, and this is divided into people who become Philadelphia chromosome positive but appear to be in chronic phase.  And half of these are people who go to accelerated phase or blast crisis.  If you look at people who had complete cytogenetic response, this is people who had complete cytogenetic remission at any time of the trial, … if you look at people who are at complete cytogenetic remission at 6 months like you are, this is probably less than 5%, so.”

“Over 4 years?”

“Yeah,” the doctor replied. “Now if you look at the curves, truth be known, there’s a steady decline.  It’s about a risk of losing progression overall in the study of somewhere between 2-4% per year.”

“Say that part again,” the patient interjects, “because I didn’t quite follow you.”

How would you respond if you were the patient at the other end of that hematology lesson?

I have not been a patient in that situation.  But just the other day I experienced my own smaller (and lower stakes) version of that state of bewilderment.  My research assistant, Lillie, came to me asking how I wanted to deal with a technical glitch on my website.  She explained my alternatives, each of which had their own pros and cons.  Something, I believe, about PHP program needed for such and such, and then something else about browser compatibility issues for whachamaheck.  And of course by now you know exactly how I responded to her: “Lillie, what do you think I should do?”  She told me which option she thought was best and I gladly accepted her recommendation.  I still have no idea what I decided!

A slew of studies in consumer psychology show that when people are overwhelmed by alternatives, they look for ways to avoid making a decision.  Place too many flavors of jam on the sampling table, and don’t expect to gain any new customers.  They’ll have so much difficulty deciding which flavor to choose, they’ll wake away without any flavor.  In medical care, on the other hand, people can’t always walk away with nothing.  They might have a serious disease like leukemia, requiring some treatment (chemotherapy versus palliative care, for example).  So rather than walk away without making a decision, they can instead simply defer to their physician. When overwhelmed by choices—especially when the choices are presented in jargon filled soliloquies—what better option than to defer to the doctor?

So docs: if you are frustrated that patients no longer accept your advice as if coming from a demi-God, just sprinkle in a few more big words, discuss a few more rare complications of each treatment choice, and the decision will be back in your hands.  Your bewildered patient will be dependent upon you for your wisdom and counsel.

On the other hand, if you want to truly serve your patients’ best interests, and share the decision making burden with them, then please take care not to overwhelm them with unnecessary detail.  And remember to use words that don’t require a medical degree to understand.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel.  He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together.

Image credit: Shutterstock.com

Prev

The unintended consequences of boilerplate guidelines

December 9, 2012 Kevin 7
…
Next

DTC genetic tests and the wilds of personal medical information

December 10, 2012 Kevin 1
…

Tagged as: Oncology/Hematology, Patients

Post navigation

< Previous Post
The unintended consequences of boilerplate guidelines
Next Post >
DTC genetic tests and the wilds of personal medical information

More by Peter Ubel, MD

  • Clinicians shouldn’t be punished for taking care of needy populations

    Peter Ubel, MD
  • Patients alone cannot combat high health care prices

    Peter Ubel, MD
  • Is the FDA too slow to handle the pandemic?

    Peter Ubel, MD

More in Physician

  • From rural communities to underserved populations: How telemedicine is bridging health care gaps

    Harvey Castro, MD, MBA
  • From solidarity to co-liberation: Understanding the journey towards ending oppression

    Maiysha Clairborne, MD
  • Finding peace through surrender: a personal exploration

    Dympna Weil, MD
  • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

    Katrina Gipson, MD, MPH
  • Beyond the disease: the power of empathy in health care

    Nana Dadzie Ghansah, MD
  • How to overcome telemedicine’s biggest obstacles

    Harvey Castro, MD, MBA
  • Most Popular

  • Past Week

    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
  • Recent Posts

    • From rural communities to underserved populations: How telemedicine is bridging health care gaps

      Harvey Castro, MD, MBA | Physician
    • 5 essential tips to help men prevent prostate cancer

      Kevin Jones, MD | Conditions
    • Unlock the power of physician compensation data in contract negotiations [PODCAST]

      The Podcast by KevinMD | Podcast
    • From pennies to attending salaries: Why physicians should teach their kids financial literacy

      Michele Cho-Dorado, MD | Finance
    • From solidarity to co-liberation: Understanding the journey towards ending oppression

      Maiysha Clairborne, MD | Physician
    • Changing the pediatric care landscape: Integrating behavioral and mental health care

      Hilary M. Bowers, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 12 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • FDA Panel Supports Tofersen for Rare Genetic ALS
  • Pregnant, Black? Here's Your Drug Test
  • Progestin-Only Birth Control Linked to Small Increase in Breast Cancer Risk
  • Fatty Acid Tube Feeding May Backfire for Preemie Breathing Disorder
  • Case Reports Detail Vision Loss Linked to Recalled Artificial Tears

Meeting Coverage

  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Second-Line Sacituzumab Govitecan Promising in Platinum-Ineligible UC
  • Trial of Novel TYK2 Inhibitor Hits Its Endpoint in Plaque Psoriasis
  • Durable Vitiligo Responses With Topical Ruxolitinib
  • Most Popular

  • Past Week

    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
  • Recent Posts

    • From rural communities to underserved populations: How telemedicine is bridging health care gaps

      Harvey Castro, MD, MBA | Physician
    • 5 essential tips to help men prevent prostate cancer

      Kevin Jones, MD | Conditions
    • Unlock the power of physician compensation data in contract negotiations [PODCAST]

      The Podcast by KevinMD | Podcast
    • From pennies to attending salaries: Why physicians should teach their kids financial literacy

      Michele Cho-Dorado, MD | Finance
    • From solidarity to co-liberation: Understanding the journey towards ending oppression

      Maiysha Clairborne, MD | Physician
    • Changing the pediatric care landscape: Integrating behavioral and mental health care

      Hilary M. Bowers, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Don’t overwhelm patients with unnecessary detail
12 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...