If you were unlucky enough to fall ill in 1900, a medical practitioner might have prescribed arsenic or mercury to "cure" your ailments. Suffering a migraine? Lounge in a hydroelectric bath. Teething baby? Try morphine syrup. Lice? One word: kerosene. These are just a few of many once-routine medical practices that have since "fallen out of favor." The pace of medicine's evolution is so rapid that it can be hard to appreciate just how far we've come. Thanks to steady advances in treatments and technologies, as well as improvements in sanitation and public health, Americans are living longer and healthier lives than ever before.
One thing, however, hasn't changed much over the past century: the importance of the patient-provider relationship. Health care provider specialization has certainly increased over the years — from physicians and pharmacists to physician assistants and nurse practitioners — but when you set aside all of the innovation in technology and various professional settings and titles, at its most basic level, medicine still comes down to two living, breathing people in a room, one seeking medical counsel and the other providing it.
How much does communication matter to patients in this relationship? A lot. According to the Association of American Medical Colleges, patients rate communication as the most important factor when choosing their doctors, ahead of board certification, number of years of practice and medical school attended. Thirty years ago, only a third of medical schools offered courses to help providers communicate with their patients. Today, every school does.
That's a big improvement, but it's still important to ask whether we are getting the job done, especially when it comes to prescription medicines. Two-thirds of office visits end with a prescription written or renewed. More than half of people in the U.S. now take a prescription medicine of some kind, and more than one in five are taking at least three. Of course, since all medicines have potential risks, and many have rare but potentially serious risks, balancing the risks and benefits of treatments is one of the most central functions that health care providers can perform during clinical care. Yet all too often, there remains a troubling gap in how successfully these risks and benefits are communicated to patients.
A new study funded by a U.S. Food and Drug Administration grant to the National Council on Patient Information and Education (NCPIE) shows that while an overwhelming majority of health care providers believe their patients adhere to prescription treatment plans, only about half of patients report high adherence. On top of that, other troubling gaps were noted. Many patients would like to spend more time discussing the medicines they are prescribed, but even when such discussions take place, doctors and patients alike may fail to consider important details. For example, over-the-counter medicines and dietary supplements are often overlooked, but these products can interact with prescription medicines and pose serious potential risks.
As medical professionals who prescribe medicines and fill prescriptions, we believe these communication gaps are significant. We want our patients and their caregivers informed as fully as possible about the potential risks and side effects of the treatments they are prescribed. This is easier said than done if you consider that primary care physicians see around 90 patients per week and spend an average of just 15 minutes with each patient. Thoroughly reviewing everything a patient should know takes time, and even when we do, sometimes it doesn't stick.
The NCPIE survey also indicates that most patients and caregivers report providers as their main source of drug safety information, whereas most providers believe patients are getting this information from other sources like pharmacists or the Internet. While about half of patients believe information about drug safety on the Internet is trustworthy, providers are much more wary, and the fact of the matter is the quality of information online is highly variable. Google searches that lead to accurate and legitimate sources of information may be helpful, but at the end of the day, there is no substitute for the clinical encounters that millions of Americans have each week with their health care providers.
Medicine still depends, arguably now more than ever, on the two people in the room having a meaningful exchange of information, and we need to continue to develop and build on this essential relationship. We got into this work to help our patients live happier, healthier lives, and that starts with our commitment to letting no question about your health go unanswered. So let's get talking.
Dr. G. Caleb Alexander is co-director of the Johns Hopkins Center for Drug Safety and Effectiveness; this editorial is written independently of his affiliation with the University. His email is firstname.lastname@example.org. Elizabeth Keyes, is chief operating officer of the American Pharmacists Association, and board chair of the National Council on Patient Information and Education (NCPIE); her email is ekeyes@APhAnet.org; Twitter: @lizkkeyes. Both authors are advisors to Talk Before You Take, a national educational campaign from NCPIE and the FDA designed to encourage increased communications between healthcare providers and patients about their prescription medicines.