Coaching can help patients ask right questions

A new Cochrane review of 33 randomised controlled trials involving more than 8000 patients from 6 countries and in a range of settings and diagnosis found that question checklists and patient coaching were the most common interventions used to help patients address their information needs, coaching produced a smaller increase in consultation length and a larger increase in patient satisfaction.


The review concluded that interventions immediately before consultations led to a small and statistically significant increase in consultation length, whereas those implemented some time before the consultation had no effect. Only interventions immediately before the consultation led to small and statistically significant increases in patient satisfaction. Read more...


"Interventions before consultations for helping patients address their information needs" - Kinnersley et al. Cochrane Library 2007, Issue 3 ( Athens password required for full text article via the HILO website )

Should doctors go to patients' funerals

Professor Bruce Arroll and colleague, Dept of General Practice and Primary Health Care, University of Auckland, explained why dcotors should consider going to their patients’ funerals in the BMJ article "Should doctors go to patients' funerals", 23 June 2007, 334:1322.

He said he had a positive experience of attending patients' funeral where the family was very appreciative of his presence. The funerals provided him the opportunity to meet the family of the deceased and talk about funeral matters with other patients.

A consultant physician said that HIV physicians " should exercise caution before attending patients’ funerals".

Read more at Medical News Today

Calmer approach to Avandia : The Lancet

Since the NEJM paper ( see posting on 25 May 2007) was published on May 21, frightened diabetes patients flooded their doctors with calls, many patients have stopped taking Avandia or switched to a rival drug Actos although some experts caution there is no urgent need for diabetes patients to stop taking Avandia.

The Lancet published an editorial online on May 23, 2007 to point out that there are important weaknesses in Nisson's meta analysis and call for "a calmer and more considered approach to the safety of Rosiglitazone" in response to the alarm raised by Dr Steven Nisson in NEJM.

According to The Lancet, the 2 most reliable studies to inform decision-making are ADOPT (published by NEJM) and DREAM (published by The Lancet). Although the results of these studies "indicate the need for more reliable information about rosiglitazone's safety", patients should calm down and wait for the results of the RECORD trial, a multi-centre study designed to monitor cardiac risk.

"How doctors think"

Dr Jerome Groopman, chief of experimental medicine at Beth Israel Deaconess Medical Center in Boston and teaches at Harvard Medical School, felt disturbed one day while he was on rounds with a group of interns, residents and medical students. He was concerned the trainees failed to question cogently or listen carefully or observe keenly and wanted to explore what goes on in a doctors's mind as he/she treats a patient.

"How doctors think" is Dr Groopman's findings of the thought processes of doctors and the errors in thinking to which they are prone drawing on a wealth of research, extensive interviews with doctors and his own experiences as a doctor and as a patient. He says that most of the mistakes doctors make are cognitive errors, many use strategies of pattern recognition to make quick decisions and are unaware of their cognitive vulnerabilities that influence their medical judgement.

He tells the story of a young woman who had been assessed and treated by numerous specialists including psychologists and psychiatrists over 15 years, but her health continued to deteriorate. The turning point came when she was referred to a gastroenterologists who was recommended to treat her irritable bowel syndrome with diet and tranquilizers. The gastroenterologist acted differently - he reconsidered her case from scratch, questioning, listening, observing and thinking differently about her illness. He diagnosed celiac disease and saved her life - " for 15 years a key aspect of her illnesses had been missed."

Dr Groopman suggests that if doctors can become more aware of their emotions, prejudices and cognitive processes in reaching a diagnosis, and in particular the role that their first impression plays in that process, they can eliminate many of these errors and can be a better caregiver.

Dr Groopman suggests that patient's story is essential in the diagnostic process because doctors need patients and their families to help provide vital information about their illnesses. Patients need to know how doctors think and ask questions to help doctors refocus their thought in making the right diagnosis.