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  Patients do not tell doctors their concerns, fears


By Karen Dente, MD

NEW YORK, May 08 (Reuters Health) - When face to face with the doctor, patients may not voice many of the concerns that prompted them to make an appointment in the first place, researchers report.

Only 4 out of 35 patients were able to voice all their concerns to their physicians, according to a survey conducted by Christine A. Barry, of Brunel University, Uxbridge, UK, and colleagues.

The most common unvoiced concerns included worries about a possible diagnosis, fears about the side effects of medication, and concern about being given an unwanted prescription. Past studies have suggested that emotional and social concerns are the least likely to be broached during appointments, according to a report in the May 6th issue of the British Medical Journal.

The patients' needs were rather complex--most had more than five items of concern, and some had as many as 18. Many of these concerns were not addressed during the patient's appointment, which can lead to miscommunication and unnecessary treatment, according to the report. In one case, a doctor prescribed antibiotics to a child because he thought the mother wanted them, when in fact, the parent had concerns about giving her daughter unnecessary medication.

"Unless overtly distressed, doctors may have trouble recognizing those who seek support," Barry said. She told Reuters Health that "doctors are in a powerful position in the relationship with patients and need to work to share information and decision-making with the patient and to encourage patients to talk."

According to Barry, the reason behind the unvoiced concerns is that "patients are behaving as they are expected to--not as they would like. They need to feel that they can voice the concerns about their illness, including their reluctance to take prescribed drugs."

Doctors should not merely be prescribing medication, but may be able to encourage their patients to communicate all their concerns, Barry added.

However, the authors of the study note the shrinking amount of time available for communication between doctor and patient.

Doctors would love to spend longer amounts of time with their patients "and are often envious of their colleagues who are alternative practitioners and get longer sessions with their patients," Barry said. In the UK, doctors spend on average 7 minutes with each patient. But, even though limited by time, "doctors should strive to be better communicators and center on the whole patient rather than just the disease or symptom and try to understand the patient situated in the context of their everyday lives," Barry told Reuters Health.

The study authors conclude that both doctors and patients need to change their behavior to improve healthcare.

SOURCE: British Medical Journal 2000;320:1246-1250.

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