A breakdown in communication

The researchers report that physicians “often fail to communicate critical elements of medication use” and do not regularly describe possible adverse effects of the drugs they prescribe.



The researchers report that physicians often fail to communicate critical elements of medication use and do not regularly describe possible adverse effects of the drugs they prescribe. Doctors, the report concludes, are spotty communicators at best.

Patient advocate groups say the findings highlight a potential threat to the public's safety that could lead to deaths and hospitalizations because of adverse reactions to prescription medications. The most critical thing that needs to be communicated is the safety information, because patients get plenty of information about how good the drug is from advertising, says Arthur Levin, director of the Center for Medical Consumers, a New York-based patient advocacy group.

Poor communication of information on side effects and adverse reactions is a potentially fatal flaw, Levin says.

The Public Citizen's Health Research Group in Washington calls the lack of information on adverse reactions a serious health problem.

The most important finding of this study is that only 35% of people are being given information by their doctors about adverse effects, says Dr. Sidney Wolfe, an internist who leads the consumer group. According to Wolfe, adverse effects to prescription drugs cause an estimated 100,000 deaths and 1.5 million hospitalizations each year.

The researchers, lead by Dr. Derjung Mimi Tarn of the University of California, Los Angeles School of Medicine, was based on 185 tape recoded patient visits to family physicians, internists and cardiologists at Kaiser Permanente and the UC Davis Medical Group in 1999 in which doctors prescribe 243 new drugs.

While the study reveals that physicians explained the justification for taking a new drug 87% of the time, the frequency of ingestion was discussed only 58% of the time, the required dose was revealed just 55% of the time, adverse side effects were explained just 35% of the time, and duration of use was described only 34% of the time.

Tarn does acknowledge that with more access to drug information in advertising and on the Internet, patients may be more proactive today during conversations with their doctors than when the study's data was collected seven years ago. But Tarn says the study's findings confirm several other investigations based on patient reports.

Although physicians acknowledge the importance of describing both common and potentially dangerous side effects of prescription medications, they say there should be reasonable expectations about how much information physicians can relay about new drugs in a short office visit with patients.

John Brodhead, an internist and chief of medicine at University of Southern California's University Hospital, tells the Los Angeles Times that doctors work under incredible time pressures during office visits with patients and part of that pressure, he contends, is created by widespread advertising by pharmaceutical companies.

Although prescription drug advertising has made patients more aware of the possibility of side effects and interactions with other medications, he says, it also has created an appetite for pharmaceuticals that is not always advisable.

How many times have you heard the phrase, Ask your doctor if such-and-such a substance is right for you's? Brodhead says. That lead to a whole lot of time spent answering questions about a drug which may be something patients don'st even need.

To protect their own safety, Levin says patients need to ask a lot of questions, do their own research on newly prescribed medications and ask pharmacists for product labels required by the Food and Drug Administration.