Physician, Hear Thyself

Taking the right medicine in the proper dosage is vital. Knowing its side effects is just as critical. But too often, physicians don't tell their patients enough about the drugs they prescribe — and sometimes they don't say anything at all.

"If I'm writing antibiotics, are you allergic to penicillin?"

"No, I'm not allergic to anything."

"Okey-dokey."

That interaction, captured on audiotape, constitutes the entire dialogue between a doctor and his patient about a drug being prescribed. No instructions on how long or how often to take the medication. Nothing on potential side effects. Not even a mention of the drug's name.

The findings of a new UCLA study indicate that such sparse communication between doctors and their patients when a new medication is being recommended is all too common. And the potential public-health implications are considerable.

Studies have found low rates of adherence (whether patients take the proper doses at the right frequency for the right length of time — or whether they take their meds at all), putting millions at risk for adverse drug events, unnecessary hospitalizations and worse.

We're talking about a lot of pills. Nearly half of all Americans are on at least one prescription medication at any given time, and half of older patients take three or more. It's estimated that every person in the U.S. is prescribed about five drugs a year.

During her medical training, Derjung Mimi Tarn Ph.D. '06 was struck by the number of patients who were coming back for repeat visits without an understanding that the medication they had been given for chronic conditions such as hypertension was supposed to be taken continuously. "I would see people who, three to four months after being prescribed the drug, had already stopped taking it," she says. "It seemed as if either we weren't telling them certain things or there was a lack of understanding of what we were saying."

To find out, Tarn, an assistant clinical professor in the Department of Family Medicine at the David Geffen School of Medicine at UCLA, analyzed data from the Physician Patient Communication Project, which examined audiotaped interactions between physicians and patients in two health-care systems in Sacramento. Publishing in the peer-reviewed Archives of Internal Medicine, she and her colleagues reported that in too many instances, physicians failed to provide the most basic facts about the drugs that they were prescribing or recommending their patients buy over the counter. "The study demonstrates spotty physician counseling about new medication prescription," the researchers wrote, which "could contribute to patient misunderstandings about how and why to take their new medications."

The doctors mentioned the medication's name 74 percent of the time, explained its purpose 87 percent, addressed adverse effects for 35 percent of the medications prescribed, noted how long the medications should be taken 34 percent of the time, instructed 55 percent of the patients as to the number of tablets they should take, and noted the frequency or timing of doses in just 58 percent of the cases.

Physicians were better at providing details when prescribing psychiatric and pain medications, which have the potential for serious adverse effects or reactions. But even there, Tarn and colleagues concluded, the overall quality of those communications was poor.

The percentage of doctors counseling their patients about adverse effects ranged from less than 15 percent of newly prescribed dermatologic and antibiotic drugs to more than 60 percent of new prescriptions for psychiatric and cardiovascular medications. Education about the length that a prescription regimen should be followed ranged from 17 percent for cardiovascular drugs to 54 percent for antibiotics.

Drawing the conclusion that lack of information on prescribed drugs could lead to their misuse or worse doesn't require a major leap. Not being aware of potential adverse effects, for example, could make patients less likely to report a problem should one occur. And not knowing the name of a drug can affect patients' ability to communicate important information in other settings, whether they're seeing other doctors or visiting an emergency room. This is a particular problem for patients with poor English fluency, Tarn notes.

Naturally, if a patient does not understand or only partially understands the purpose for which a medication was prescribed, that could make the patient more likely to misuse it — to take a blood pressure medication for pain, for example — or to simply forgo filling the prescription.

One explanation for the poor showing among physicians in the study may be that medical practitioners assume pharmacists will provide patients with these and other facts, including how many pills to take, how often, and for how long. But Tarn notes that the educational role of the pharmacist vis-à-vis the physician is not clearly spelled out, and in practice varies widely.

Moreover, while that type of misunderstanding might be a factor, Tarn has observed that the most common reason for the spotty communication between doctor and patient comes down to the clock. "The visits are short, and many doctors feel pressed for time," she says. So patients can get the message that questions are not welcomed, and are reluctant or embarrassed to seek clarity.

"If patients have any questions," Tarn says, "they need to be assertive in making sure those questions are answered before they leave the doctor's office."

The Perscription Top 10

Protect your health. Ask your doctor or pharmacist these questions from the U.S. Agency for Healthcare Research and Quality. And for more tips, log on to www.ahrq.gov.

• What is the name of the medicine?
• What is its purpose?
• Will substituting a less expensive generic medicine for the name brand achieve the same effect?
• What are the dose and frequency with which the medicine should be taken?
• What should I do if I miss a dose or accidentally take too much?
• How long should I continue to take the medication?
• Are there any foods, drinks, other medicines or activities I should avoid when taking the drug?
• How long should it take for the medication to work, and how do I know if it is working?
• What are the possible side effects, and what should I do if they occur?
• Is there any written information I can take home with me?

Published Jan 1, 2007 8:00 AM