“How can a patient, who does not know what meds she is on or why, seriously participate in ‘Shared Decision Making’?”
I apparently struck a nerve with several followers who replied with tweets accusing me of not educating the patient, wondering why she doesn’t know, wondering if she might be on too many meds [ya think?], etc. One response was from a software developer who likened doctors to technology professionals, patients to computer users and computers to medications. None of those who confronted me is a physician. I am not sure what types of front line experience with patient care they have had.
Let me clarify a few things.
I am certainly not against explaining things to patients. I believe they should understand what treatments they are agreeing to. My point was I think a substantial number of patients do not really understand things even when they are explained at length.
I was seeing the patient as a consultant. I am not her primary care physician [PCP]. The problem of patients not knowing what medications they take is very common. An informal poll of some of my physician colleagues reveals that as many as 50% of the patients we see in our emergency department do not know what meds they are taking, why they are taking them and they do not have a written list of current meds in their possession.
Many studies show similar results. Researchers at the Mayo Clinic found that patients discharged from the hospital had significant problems recalling the names of any new meds prescribed or their dosages. A study of patients seen in the emergency department at UCSD showed, “Only 48% of patients could recall or produce a list or the actual bottles of all of their medications, 39% knew the times they take their medications, and only 24% knew all the dosages.”
The PCPs and hospitalists where I practice take great pains to educate their patients on the need to know their illnesses and medications. They have all been instructed about the importance of this and the need to carry a list of their medications at all times.
They simply do not do it. Why not?
I don’t know but I have some ideas. I practice in the real world. Most of my patients are nice people who are very down-to-earth types. Some are on too many meds. Some are old. Some are confused as a result of their illnesses and/or their meds. Some are anxious. Some are mentally ill. Some are “all of the above.”
But [you won’t like to hear this] many just do not want to take responsibility for their own health. I think they don’t know their meds for the same reason they eat too much, smoke too much, drink too much and don’t exercise.
Go ahead and blame us doctors for not educating the masses. I say, keep trying, but don’t be disappointed when half of them don’t comprehend the importance of what you are trying to do or possibly just don’t care.
While I’m on shared decision making, I have this final comment. Physicians should not present three options with lengthy dissertations on the myriad side effects of treatment and no real advice as to what would be best for the patient. You cannot teach someone the anatomy, physiology or the nuances of medical care in a shared decision making discussion. How can a patient make a rational choice without guidance from the physician?