Doctors and patients divided about new guidelines

There was considerable confusion last fall when the United States Preventative Services Task Force changed its recommendations regarding mammogram screenings for women age 40-49. Several months later, a report in the Annals of Internal Medicine, as reported by The New York Times, says that there is a divide between physicians and patients regarding following those recommendations. Physicians are more likely to follow the guidelines, which recommend women start routine screening at age 50 and be screened every other year, while patients are more likely to want more frequent screenings as previously recommended.

The disparity points to the continued communication challenge, as physicians and patients must clearly convey their desires and reasoning for screening procedures.

Researching and trusting your doctor

Dr. Pauline Chen wrote her column yesterday about Angie's List, an online community where participants can rank and review service providers, and now allows patients to rank their physicians. Dr. Chen observed how when reviewing service providers such as roofers, participants detailed the quality and competence of work, often giving details such as supplies used, quality of technique and even photos of finished products. But when ranking doctors, patients consistently ranked physicians higher for things such as attentiveness, and gave failing grades to physicians who were brusque and rushed. But the reviews of physicians said little about physician's actual medical skills. Dr. Chen then goes on to discuss the difficulties patients have in assessing and researching physician skill and competence, and why patients need to take an active part of their health care by researching and knowing about their physicians.

You can find the column here: http://www.nytimes.com/2008/12/19/health/18chen.html?partner=permalink&exprod=permalink

And the blog and comments here: http://well.blogs.nytimes.com/2008/12/18/in-doctors-we-trust/

What do you think? How should patients take a more active role in their health care? How can patients do this without putting physicians on the defensive?

transparency in medical practice

The Milwaukee Journal Sentinel has been running a series of articles on medical malpractice in Wisconsin. You can find part 1 here: http://www.jsonline.com/story/index.aspx?id=711582 and part 2 here: http://www.jsonline.com/story/index.aspx?id=711730.

Reading these articles makes me wonder if some of the problems between doctors and patients and lawyers would be resolved by greater transparency in the medical profession. I'm not just talking about disclosing errors, but teaching the public about the medical profession, about what it takes to be licensed and what we can expect of physicians and other medical professionals. What is an error, what is negligence, what is a mistake. What are the acceptable outcomes for a given treatment? Greater transparency and greater understanding would be a foundation for greater trust between patients and physicians and between physicians and the public. And it would be easier than the defensiveness generated by malpractice lawsuits.