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Doctors Often Misinterpret Patients' Wishes, Study Says

Such 'preference misdiagnosis' can lead to costly, unwanted treatments

FRIDAY, Nov. 9 (HealthDay News) -- Doctors often ignore or misunderstand what patients want in terms of treatment, and this "preference misdiagnosis" can be harmful to patients, experts say.

The authors of a new report say a doctor cannot recommend the right treatment without fully understanding a patient's preferences, yet evidence suggests there are often large gaps between what patients want and what doctors think they want.

For example, one study found that doctors believed that 71 percent of breast cancer patients rated keeping their breast as a top priority, but the actual number was just 7 percent, said Albert Mulley from the Dartmouth Center for Health Care Delivery Science in Hanover, N.H., and colleagues.

Another study found that patients with dementia placed much less value than doctors on staying alive with severely declining mental function. And a third study found that patients may change their treatment preference when informed about its risks and benefits. For example, 40 percent fewer men preferred surgery for benign prostate disease after they learned about the risks of sexual dysfunction.

Ensuring that treatment matches a patient's preferences is not as simple as asking what a patient wants, but requires three specific steps, said the authors of the article, published online Nov. 8 in the BMJ.

The three steps are: a mindset of scientific detachment; the use of data to arrive at a provisional diagnosis; and including the patient in three phases of decision making -- team, option and decision talk.

Along with being the ethical thing for doctors to do, fully understanding patients' preferences may also help reduce health-care costs, the researchers said. They noted that studies show that engaged and informed patients often choose to have less-intensive care and are more careful about having lots of procedures.

"It is tantalizing to consider that budget-challenged health systems around the world could simultaneously give patients what they want and cut costs," the researchers concluded in a journal news release.

More information

The American Academy of Family Physicians offers tips for talking with your doctor.

SOURCE: BMJ, news release, Nov. 8, 2012

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