In the dark about pills’ side effects
During her clinical work as a young physician, Dr. Derjung Mimi Tarn treated a number of patients who failed to realize they needed to continue taking medications for their chronic conditions.
She wondered whether poor communication by their doctors might have been partly responsible.
It would appear so. In a study published in the Sept. 25 issue of the Archives of Internal Medicine, Tarn and five colleagues found that physicians “often fail to communicate critical elements of medication use” and do not regularly describe possible adverse effects of the drugs they prescribe.
For patients who’ve left medical appointments in a deep state of confusion, a study concluding that doctors are “spotty” communicators may be at least some more important, patient advocates said, the findings spotlight a potential threat to the public’s safety, one that could lead to deaths and hospitalizations due to adverse reactions to prescription drugs.
“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,” said Arthur A. Levin, director of the Center for Medical Consumers, a nonprofit advocacy group in New York.
When physicians don’t do a good job of describing side effects and adverse reactions to their patients, he said, “that is a potentially fatal flaw.”
Dr. Sidney Wolfe, an internist who directs the nonprofit consumer group Public Citizen’s Health Research Group in Washington, D.C., said that the inadequacy of information patients get about adverse drug reactions was “a serious public 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,” he said, adding that adverse effects to drugs cause an estimated 100,000 deaths and 1.5 million hospitalizations a year.
Tarn, an assistant professor of family medicine at UCLA School of Medicine, based her research on 185 patient visits in which doctors prescribed a total of 243 new medications.
The tape-recorded visits were culled from a larger sample gathered in 1999 for a study on patient request fulfillment.
The visits involved doctors from Kaiser Permanente and the UC Davis Medical Group in Sacramento -- 16 family physicians, 18 internists and 11 cardiologists -- who volunteered to participate.
Tarn and her fellow researchers gave doctors one point for telling a patient the name of a medication; one point for describing the justification for taking it; one point for explaining its duration of use; one point for describing possible adverse side effects; half a point for describing the number of tablets or sprays to be taken; and half a point for explaining the frequency of ingestion.
Overall, the study produced a mean score of 3.1, meaning that doctors communicated 62% of the information required for a perfect score.
The study found that physicians explained the justification for taking a new drug 87% of the time.
But they used the trade or generic name for a newly prescribed drug 74% of the time; described the frequency of ingestion 58% of the time; specified the number of tablets or sprays 55% of the time; explained adverse side effects 35% of the time; and explained duration of use 34% of the time.
Tarn, 34, said it was possible that doctor-patient communications had improved since the study was conducted.
The visits were recorded seven years ago, and patients now have access to much more information -- both on the Internet and through heavy advertising by pharmaceutical companies. These new sources of information, she said, may lead patients to be more proactive during their conservations with doctors.
But the study’s findings, she said, confirm those of numerous previous research efforts, which were based primarily on patient reports.
“It was common for the physicians in our study to neglect giving specific directions about how to take medications,” the study says. “The following exchange is a physician’s complete set of instructions to a patient about an antibiotic:
“Physician: ‘If I’m writing antibiotics, are you allergic to penicillin?’
“Patient: ‘No, I’m not allergic to anything.’
” Physician: ‘Okey-dokey.’ ”
Dr. John L. Brodhead Jr., an internist who is chief of medicine at USC’s University Hospital, agreed that physicians must describe the side effects -- both common and potentially dangerous -- of the medications they prescribe.
But he said that there should be reasonable expectations about the amount of information physicians can provide about medications, given the “incredible time pressures” they often work under during office visits.
Indeed, part of that pressure is created by ubiquitous advertising by pharmaceutical companies, he said.
Though it has clearly made patients more aware of the possibility of adverse side effects and interactions prescription drugs can have with one another, Brodhead said, advertising has also 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,’ ” Brodhead said. “That leads to a whole lot of time spent answering questions about a drug which may be something [patients] don’t even need.”
Levin’s advice to patients: “You need to ask a lot of questions, you need to try -- if you’re capable -- to do research on your own, and can actually ask a pharmacist for the product label, which is something daunting, but it has all the information required” by the Food and Drug Administration.
