American College of Physicians: Internal Medicine — Doctors for Adults ®

MKSAP ® 15
Assess your knowledge, prep for the boards, and earn CME credits and MOC points with the best self-assessment program.

Thursday, February 9, 2012

Not all doctors fully disclose errors, pharma ties, bad prognoses

One-third of surveyed physicians did not completely agree that they should disclose serious medical errors to patients, two-fifths said they did not completely agree that they should disclose their financial relationships with drug and device companies to patients, and that one-tenth said in the previous year they had told patients something that was not true.

It seems the patient-centered medical home needs a few small repairs.

Researchers surveyed 1,891 physicians from internal medicine, family practice, pediatrics, cardiology, general surgery anesthesiology and psychiatry nationwide in 2009 to find out if they followed the standards on communication laid out by the American Board of Internal Medicine Foundation’s Charter on Medical Professionalism, which was co-authored by the American College of Physicians. The survey excluded osteopaths, residents and those who practiced in federally owned hospitals.

Results are published in the February 2012 issue of Health Affairs.

Nearly 20% of physicians said they had not fully disclosed an error to a patient in the previous year because they feared the admission would trigger a malpractice case, even though some studies show that prompt communication about an error can reduce anger and make patients less likely to sue.

Other important findings from the survey are:
--More than 55% of physicians said they often or sometimes described a patient’s prognosis in a more positive manner than warranted;
--Women and under-represented minority physicians were significantly more likely to follow the Charter’s provisions than their white male counterparts; and
--More than a third of physicians did not completely agree that they should disclose all financial ties with drug and device makers to patients.

Women were more likely to report never lying, fully describing benefits and risks, disclosing financial relationships, and never having told an untruth in the prior year.

Race or ethnicity was significantly associated with never telling a lie and never disclosing confidential information. In both instances, underrepresented minorities were more likely than white or Asian respondents to report attitudes consistent with charter commitments.

International medical graduates were more likely to respond never lying, never disclosing confidential patient information, and never having revealed confidential information.

General surgeons and pediatricians were most likely to completely agree about needing to disclose all serious medical errors to patients, while cardiologists and psychiatrists were least likely (P less than 0.001). Anesthesiologists, general surgeons and pediatricians were most likely to report never having described patients' prognoses in more positive terms than warranted, while internists and psychiatrists were least likely (P less than 0.05). Cardiologists and general surgeons were most likely to report never having told patients an untruth in the previous year, while pediatricians and psychiatrists were least likely (P less than 0.001).

Physicians in universities or medical centers were more likely to completely agreed with the need to report all serious medical errors than physicians in solo or two-person practices (78.1% vs. 60.5%; P=0.03). Those practicing in regions with the lowest third of malpractice claim rates were more likely to agree that physicians should fully disclose financial ties to drug and device makers compared with physicians in regions with the highest third of malpractice claims (68.9% vs. 60.9%; P=0.40).

And, even though the survey was anonymous, it's likely to underestimate the rate at which physicians do not comply, the authors wrote. The reasons why are more subtle, however.

"The survey results suggest that many physicians do not completely support the charter requirements related to communication with patients. An alternative interpretation is that treating support for the charter precepts as 'black or white'--physicians either do or do not completely endorse and adhere to these principles--fails to recognize complexities of patient physician communication in everyday practice," the authors wrote.

"Despite the relative clarity and unambiguous language of the charter precepts, many factors can affect how and what physicians communicate to patients," they continued. "Some might argue that knowing when to breach or bend these rules-when individual patients require a different approach constitutes clinical wisdom and true patient-centeredness."

Labels: , , ,

posted by Ryan DuBosar at 7:00 AM  

0 Comments:

Post a Comment

Subscribe to Post Comments [Atom]

<< Home

Share

 

Contact ACP Hospitalist

Send comments to ACP Hospitalist staff at acphospitalist@acponline.org.

Previous Posts

Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internist and ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

CasesBlog
Ves Dimov, MD, ACP Member, is an allergist/immunologist and Assistant Professor of Medicine and Pediatrics at the University of Chicago, where he evaluates and treats both pediatric and adult patients.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
ACP Member Mike Aref, MD, PhD, ACP Member, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, ACP Member, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Musing of an Internist
Justin Penn, MD, ACP Associate Member, attended medical school at the University of Washington School of Medicine and trained in internal medicine at the University of Rochester, where he is serving as Chief Resident.

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

White Coat Underground
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

Powered by Blogger

RSS feed