A new study from the University of Illinois revealed what’s really happening in the exam room. The study uncovers what doctors talk about with their patients.
It appears that physicians are more focused on recommended guidelines, such as prescribing certain medications for chronic diseases like diabetes or hypertension, instead of finding out why prescribed medications stop working in the first place.
When desired outcomes are not met, doctors tend to increase a patient's medication, or add another one, without exploring the reason behind a patient's set back. For example, did the doctor check if the patient is skipping a dose because of forgetfulness (especially when dealing with the elderly)? Did the patient stop taking their medications because it’s no longer affordable? Is the patient continually missing appointments? The study clearly shows that doctors are missing a lot of red flags during office visits that can improve patient outcome.
I am not suggesting that doctors who are not patient-centered are incompetent. All I'm saying is that when a patient’s health status is deteriorating, doctors may not explore the reasons deeply enough to uncover the answer. Before adjusting the medication and sending the patient home with an additional prescription, it would be more helpful if doctors paid attention to some of these red flags that can be easily missed during a ten minute office visit.
The health system needs to be challenged in order to improve patient care by considering the totality of the experience through the eye of the patient, not the doctor. So, where does the nurse fit into all of this?
There are definitely some key takeaways here that apply to all medical disciplines, including oncology. This is a time when nurses and nurse practitioners can help serve as another level of care to ensure that cancer patients' needs are being met, whether that's offering the patient appropriate medications, or even psychological care. We also need to sometimes dig a little deeper in order to find out what's really going on -- additional comorbidities can have an effect on an oncology patient receiving cancer treatment.
We have many patient-centered care guides in the health community. I think medical education needs to include patient-centered skills and interviewing practices in the curriculum, whether in medical school or during residency.
We always say that patients need to be an advocate for their health and need to do their homework prior to their doctor’s visit. However, patients may not always be able to accurately assess the clinical quality of their care for multiple reasons. For example, if patients have diminishing memory and cognitive abilities, they are the last person to know if their diabetes is getting out of control or their kidney function is deteriorating. In this case, it’s the doctor’s job to be more aggressive in addressing the problems to address the underlying cause.
Patient-centered care does not replace excellent medicine; it both complements clinical excellence and contributes to it through effective partnerships and communication.