MONDAY, March 28, 2005 (HealthDay News) -- Philip Greenland's 89-year-old mother had been hospitalized after a fall, and there were indications she might have suffered a hip fracture requiring surgery.
But over seven days of hospitalization, the orthopedic surgeon in charge of her case "began to act as if any inquiry from my mother or the family was a bother to him," Greenland said.
The surgeon failed to visit the woman for three days in a row and finally failed to review the bone scan that would show a fracture. Greenland then transferred his mother's care to another doctor, who readily concluded the hip was indeed fractured and operated within 12 hours.
As it happens, Greenland is a physician himself, professor of preventive medicine at Northwestern University and editor of the journal Archives of Internal Medicine. He told his story in an editorial in the March 28 issue of the magazine filled with articles devoted to the topics of professionalism in medicine, medical ethics and doctor-patient communication.
The practice of medicine has become a complicated business lately, Greenland said, with overworked doctors often failing to communicate and failing to show respect for those in their care. His editorial quoted a 1927 paper that said "one of the essential qualities of the clinician is interest in humanity."
"I can now say from personal experience that anything less will not satisfy us when our own relatives are sick," Greenland wrote. "Why should we be willing to settle for less when someone else's mother, father, husband, wife, son or daughter is the patient?"
Five papers in the journal covered different aspects of how that basic principle can be put into practice -- and how it can be neglected.
For example, a study by researchers at Harvard Medical School found that 23.2 percent of people infected with HIV, the virus that causes AIDS, had physicians with negative attitudes toward those addicted to injected drugs, and that those patients "had a significantly lower rate of exposure" to aggressive drug treatment.
A study led by Dr. G. Caleb Alexander, an affiliate faculty member at the University of Chicago MacLean Center for Medical Ethics, looked at one of the touchier issues in medical practice -- the high cost of drugs. A survey of 519 doctors sought to learn why they often failed to discuss those costs with the patients in their care.
"We've identified several barriers," Alexander said. "The main barriers are insufficient time and lack of habit of conducting such discussions. Physicians are pressured for time, and they might not feel they have the time to talk about the issue." In addition, doctors just might not know how much money people are spending on prescription drugs, he said.
But people often feel uncomfortable telling doctors they may not be able to afford drugs that are prescribed for them, and "some patients may be concerned that their care would be compromised if cost is considered," Alexander said.
The study did not address the even more sensitive issue of drug company advertising and its potential influence on doctor's prescribing practices, but "there are a wealth of studies suggesting that advertising has an impact on prescribing practice," he said.
At the University of Toronto, Dr. Wendy Levinson, professor and chairwoman of medicine, looked into an equally sensitive issue -- the effect on medical care of financial incentives, such as health maintenance organizations telling doctors to avoid expensive tests or procedures whenever possible.
The study presented 2,765 people with a test case: a video showing a discussion between a doctor and patient about a proposed magnetic resonance imaging (MRI) test. Nearly all the people had heard of managed care incentives, and 80 percent of them said they wanted to be told if they existed or might play a role in their care.
The study looked at six different strategies for a doctor to pass along that information. The one that worked best was "addressing emotions," with the doctor saying, "I understand your worries and am ready to address them," Levinson said. A strategy of "negotiation," with the doctor discussing the issue at length with the patient before reaching a conclusion, worked nearly as well.
What didn't work was the "common enemy" strategy, with the doctor saying, "I'd like to get you the test, but the health plan won't let me do it." Equally ineffective was the doctor denying that money played any part in the decision, she said.
The value of this and the other studies is that doctors are learning the importance of communicating with the people in their care, Levinson said. It is showing up in situations where the doctor knows that the patient cannot survive long.
"Years ago we didn't talk about dying," Levinson said. "We now feel that this is an appropriate approach. In the same way, we can talk about finances and how they affect the doctor-patient relationship."
Medical schools "have really enhanced their teaching of communication," and "it can be taught throughout a physician's career," she said. "There is a need for effective teaching of physicians at all layers of education."
More information
The American Medical Association offers more on medical ethics.
