Patients Still Respect Evidence

A recent survey about patient attitudes and desires with regard to health care demonstrate that respect for scientific evidence is still the dominant factor in preferring treatments. (Full study) This is good news, although the numbers could be better.

Researchers asked subjects what factors were important in determining which treatments they would prefer, the scientific evidence, the experience of the clinician, or their own personal preferences. Not surprisingly, most subjects wanted it all, agreeing that all three are important. Scientific evidence, however, scored the highest with 71% rating it as very important (and over 90% as important or very important). Clinical expertise had 61% strongly supported and personal preference, 57%.

Further, patients wanted their doctors to talk to them about the evidence. The phrase they felt had the most impact on their decision to accept a treatment was, “What is proven to work best.”

All of this matches my personal experience as a clinician. At least for the self-selective population of patients who seek out a university physician, patients tend to find recommendations based upon published evidence compelling, and greatly appreciate when I take the time to tell them about the evidence, even if it goes against their initial interests.

Patients, for example, frequently ask me what I think about acupuncture,  a particular supplement, or some other “alternative” treatment for their condition. I tell them – without waffling or watering down my opinion. I don’t editorialize or express judgmentalism because that is inappropriate in a therapeutic context, but I tell them my understanding of the published scientific evidence and the plausibility of the treatment, and then give them my bottom-line recommendation. I do this as if I were talking about any treatment option. Even when patients are starting from a very different opinion about the treatment, they appreciate the fact that I have taken the time to look into the research and to communicate that to them.

This is exactly why the “shruggie” approach to unconventional treatments is counterproductive and a huge disservice to patients. Saying, “I don’t know” when asked about an implausible and ineffective treatment, or even giving a dismissive response, is not going to be convincing to patients.

The survey also found that taking the time to communicate to patients about the scientific evidence greatly improves their satisfaction with their health care – another way in which the dismissive approach has a negative impact.

Despite an ongoing effort by some promoting treatments that are not science-based, there is still huge public support for science in general and science-based treatments. That is why proponents of dubious treatments are so desperate for the trappings of scientific legitimacy, even to the point of rewriting the rules of science to accommodate their preferred treatments.  This is turn leads to the need to have watchdog groups defending the role and integrity of science in the practice of medicine.

The bottom line of this survey is that patients respect evidence and want their physicians to talk to them about it, although only 35% reported that their doctors take the time to explain the latest medical evidence. In order to improve this situation physicians need to understand the evidence not only for treatments they use, but also for treatments their patients are likely to ask them about, including CAM therapies.

I need to point out that, like all surveys, this data needs to be taken with a grain of salt. How questions are asked has a significant impact on how they are answered. Also, it would have been interesting to have control questions, asking patients how they feel about treatments that are not based on evidence, or that are based upon tradition or treatments for which a possible mechanism is not understood by science. Would patients accept a treatment that is lacking evidence or even if the evidence indicates it does not work if it were supported by anecdotal evidence? This survey, it can be argued, had a significant bias toward scientific evidence.

Regardless of the limitations, it does draw attention to the need for physicians to engage with individual patients, and, I would argue, the broader society, about the role, methods, and findings of science in medicine.

Posted in: Science and Medicine

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10 thoughts on “Patients Still Respect Evidence

  1. windriven says:

    “[O]nly 35% reported that their doctors take the time to explain the latest medical evidence.”

    This points up a difficult situation for physicians as well as patients. Physicians, especially those with large patient populations on Medicare and Medicaid are have little recourse but to see a lot of patients every day – because they are paid at relatively low rates for these visits. ACA will likely exacerbate this problem as part of its strategy is to trim compensation levels. This militates against more thorough intercourse.

  2. pharmavixen says:

    As a pharmacist, I have found that I run into conflicts when I’m busy and don’t have the time to explain everything in a fulsome way. So it’s the height of cold/flu season, my tech is sick and I’m by myself, a long line of unhappy people waiting for their rxs for antibiotics (for what are likely to be mainly viral infections – sigh!) and somebody asks about a homeopathic remedy for their child’s earache. Handling these sorts of queries in a non-dismissive way that respects the patient’s concerns means that a lot of cranky people have to wait longer for their prescriptions.

  3. Janet says:

    This leaves the problem of MD’s flirting openly with sCAM ala Dr. Oz, Dr. Weill, Dr. Sears, et al. A directory published by the food co-op in my city (which claims a large teaching hospital) and widely distributed has dozens of ads for physicians (MD’s and some DO’s) who advertise their use of any number of alternative therapies from acupuncture, to saliva testing, to all sorts of manipulative “therapies”. If these are used in conjunction with standard treatment, one could take a shruggie approach, but the same people who seek these docs out are likely the 35% who don’t trust science to begin with.

    I don’t worry so much about the people (adults, anyway) who use sCAM, but I do worry about the children of these people and about the doctors who enable them, whether out of shrugginess or what I would think should constitute malpractice.

    I have lived in two small towns where it is difficult to find an MD who does NOT practice sCAM or shrug it off as part of living there. The one I finally found said she thought it was limiting her practice to not at least be a shruggie.

    So, while I’m trying to find your report optimistic, I will hope that my personal experience is unusual.

  4. “[O]nly 35% reported that their doctors take the time to explain the latest medical evidence.”

    Honestly, to the majority of people, if you precede a statement of medical advice with “The best evidence suggests…” they’d probably be pacified. It instills confidence in the patient, in their treatment, and their provider, it makes them feel like they’re getting the best treatment possible, and it makes them feel like they have now been explained the latest evidence. I doubt many patients want to here “well, in 2010 there was a double blinded randomzied trial in which two groups of 500 men were each ….” Not to mention the sheer amount of time that steals from your day. Things that add 4-5 minutes per patient, when done over 20 times per day, really start to add up.

  5. mho says:

    As a patient, I’d be happy to have a handout that explains what evidence-based means, and a few questions to ask yourself when presented with recommendations by friends, naturopaths, acupuncturists and vitamin store clerks–something a bit more specific than “ask your doctor”.

    My surgeon in 1998 gave a splendid rant about how hard the AMA had worked to assure that we got real medicine, not snake oil. She told me if I had money to spare she’d much rather see me send $30 a month to the American Cancer Society than spend it on vitamins I didn’t need that I’d end up peeing down the toilet. She had already saved my life (advanced cancer) so I took her word as gospel most of the time, although she ALWAYS knew and referred to the studies that led to her answers. The rant didn’t come out of the blue-it was part of a discussion we were having. Mostly, we took her advice because she listened and explained what was known and what wasn’t with great compassion, respect and empathy.

  6. Whew, Obama just got his ass handed to him by Romney! Wooho!

  7. BillyJoe says:

    Don’t despair, there are two debates to go.

  8. mousethatroared says:

    BillyJoe – You have to understand, Barak was thrown off his game by the cognitive dissonance reverberating from Mitt. What logical person wouldn’t be disturbed by that?

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