Interesting Facts about Doctors & Patients

1Diagnostic mistakes

How frequently do doctors misdiagnose patients? In fact, it is not known for sure how many people suffer from misdiagnoses. The answer is probably higher than patients expect and certainly higher than doctors realize. When compared to the fifth leading cause of death in the US, medical errors fall just below.

A recent 2014 study1 found that about 12 million people in the US are misdiagnosed each year - in other words 1 in every 20 adult patients.

In a Supplement to the issue of The American Journal of Medicine, a collection of articles and commentaries sheds light on the causes underlying misdiagnoses and demonstrates a nontrivial rate of diagnostic error that ranges from 5% in the perceptual specialties (pathology, radiology, dermatology) up to 10% to 15% in many other fields2. Physician overconfidence and a lack of feedback following a diagnosis are the major contributors to diagnostic errors.


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2 Who prescribes antibiotics inappropriately? Foreign, extra-busy and older MDs

When it comes to inappropriate antibiotic prescribing, all physicians are not created equal. Canadian study3 found that the doctors most likely to prescribe antibiotics in error are those who've been in practice longer, see more patients or trained outside Canada or the US.

The study found that international medical graduates are a shocking 78% more likely than Canadian- and American-trained MDs to give antibiotics inappropriately. That correlation, however, doesn’t appear to be explained by poor knowledge. Some countries, Spain foremost among them, simply have more liberal attitudes about antibiotics. The study also found that doctors who see an average of 34 or more patients per day are 20-27% more likely to give antibiotics where they are not appropriate. The research also showed that for each year a physician is in practice, their rate of inappropriate prescribing increases 4%.

3 Doctors' choice of prescriptions are often influenced by their patients.

Physicians' choice of prescriptions are often influenced by patients. Researchers found4 that a patient's experience with specific medications plays an important role in prescription decisions, but that patients' influence diminishes when the doctor is a specialist, and that they have no influence when specialists are treating severe symptoms.

4 How are addicted physicians treated?

Physicians are just as likely to abuse alcohol and illegal drugs as the other people, but are much more likely to overuse prescription drugs due to their close access to medicines5.

However, doctors with substance use disorders receive medical care that is of higher quality and significantly more effective than that offered to the general population6.

5 Free drug samples affect prescribing

  • Distribution of free drug samples is one of the main advertising methods used by the pharmaceutical companies. When a pharmaceutical company puts drug samples into the hands of doctors as a form of marketing, how does it influence their prescribing choice? One in three doctors agrees that free drug samples influence prescribing, finds a small but representative US survey published in the Journal of Medical Ethics7. The availability of drug samples often leads doctors to prescribe medications that differ from their preferred choice8.
6

Patients treated with respect more likely to follow medical advice

Attention doctors: Want patients to follow your advice? Treat them with dignity. Patients treated with dignity are more likely to achieve higher levels of satisfaction with their care, adhere to therapy and get preventive services9.

7Doctor-Patient communication has a real impact on health

Good doctor-patient communication makes a difference not only in patient satisfaction but in patient outcomes including resolution of chronic headaches, changes in emotional states, lower blood sugar values in diabetics, improved blood pressure readings in hypertensives, and other important health indicators10.

8 Patients want to shake hands with their physicians

When it comes to the doctor-patient relationship, patients have some pretty specific ideas about how they want their doctors to greet them when they first meet.

The research from Northwestern University Feinberg School of Medicine, Chicago, shows that most patients want their doctors to shake their hands, greet them by name, and introduce themselves using their first and last name when they first meet11.

This study found that, among patients:

  • 78.1% wanted physicians to shake their hands, while 18.1% did not
  • 50.4% wanted their first names used during greetings, 17.3% preferred their last name and 23.6% favored the physician using both first and last names
  • 56.4% wanted physicians to introduce themselves using first and last names, 32.5% expected physicians to use their last name, and 7.2% would like physicians to use their first name only

9 7 things patients expect from doctors

If you ever felt like your doctor was trying to push you out of the examination room before you had a chance to explain your condition, you are not alone. A study from the Mayo Clinic12 demonstrated that most people agree on what makes a good doctor and it definitely isn’t one who hurries through a visit. A doctor’s people skills can affect a patient’s emotional response and recovery very positively or very negatively, research shows. According to this study an "ideal" physician should be:

  • Confident
  • Empathetic
  • Humane
  • Personal
  • Forthright
  • Respectful
  • Thorough

10 Surgeons are taller and better looking than other doctors

Doctors at the University of Barcelona Hospital noticed that the tallest and most handsome male students were more likely to go for surgery, and the shortest (and perhaps not so good looking) ones were more likely to become physicians. So they decided to test the theory that, on average, surgeons are taller and better looking than physicians.

The study revealed that, on average, senior male surgeons are significantly taller and better looking than senior male physicians13. Also, film stars who play doctors are significantly better looking than real surgeons and physicians.

11 Patients often receive incomplete drug instructions

Physicians prescribing new medication often do not say to patients important details, such as potential side effects, how long or how often to take or the specific name of the drug14.

The study demonstrated that doctors communicated an average of 3.1 of the 5 essential elements, indicating that only 62% of the necessary information was conveyed. Physicians used the specific name for 74% of new prescriptions, explained the purpose for 87% and discussed adverse effects for 35%. 34% of the encounters included instructions on how long to take the drug, 55% on the number of tablets to take and 58% on the frequency or timing of use.

12 Disclosure of medical errors

There is a gap between physicians’ attitudes and their real-world experiences admitting medical errors. Physicians may say they would disclose a medical error, but how many actually do? From a survey of faculty physicians, resident physicians and medical students, researchers from the University of Iowa found that while nearly all respondents indicated that they would disclose a hypothetical error, less than half reported having disclosed an actual medical error.

13 The highest rate of “Off-label” prescriptions accounts for Antidepressants, Anticonvulsants, and Antipsychotics

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The researchers from the University of Georgia examined data on drugs prescribed to 107,000 Georgia Medicaid recipients in 2001. They found that 75% of antidepressant recipients, 80% of anticonvulsant recipients and 64% of antipsychotic recipients received at least one of these medications off-label. Many patients have no idea that this goes on and just assume that the physician is writing a prescription for their indication.

Off-label use of central nervous system drugs can account from anywhere from 25 to 80% of a drug’s annual sales. In the case of the Neurontin (gabapentin) nearly all – 98% – of patients received the drug off label in 2001.

14 Medical myths even doctors believe

Even physicians sometimes believe medical myths contradicted by scientific evidence. In a study published in the British Medical Journal, Indiana University School of Medicine researchers explored seven commonly held medical beliefs15:

  • 1. People should drink at least eight glasses of water a day
  • 2. We use only 10% of our brains
  • 3. Hair and fingernails continue to grow after death
  • 4. Shaving hair causes it to grow back faster, darker, or coarser
  • 5. Reading in dim light ruins your eyesight
  • 6. Eating turkey makes people especially drowsy
  • 7. Mobile phones create considerable electromagnetic interference in hospitals

Despite their popularity, all of these medical beliefs range from unproved to untrue.

15 Majority of U.S. doctors believe religion is beneficial for patients’ health

More than half of physicians believe that religion and spirituality have a significant influence on patients’ health16.

According to the research about 76% of physicians believe that religion and spirituality helps patients cope, 74% believe that it gives patients a positive state of mind and 55% report that it provides emotional and practical support through religious community.

16 Americans' trust in doctors is falling

Public trust in U.S. physicians has declined sharply over the past half century. In 1966, about 73% of Americans said they had great confidence in the leaders of the medical profession. In 2012, only 34% expressed this view18.

17 Psychiatrists are the least religious of all doctors

A nationwide survey of the religious beliefs and practices of U.S. physicians has found that the least religious of all medical specialties is psychiatry17. Among psychiatrists who have a religion, more than twice as many are Jewish and far fewer are Protestant or Catholic, the two most common religions among physicians overall.

18 However, psychiatrists are most interested in patients’ religion

Although psychiatrists are among the least religious physicians, they seem to be the most interested in the religious and spiritual dimensions of their patients. The researchers19 examined results from a survey of 100 psychiatrists and 1,044 non-psychiatrists from across the United States. The researchers found that psychiatrists are twice as likely (46% and 23% accordingly) as other physicians to say that patients often mention spiritual issues. They are also much more likely to both say that it is appropriate to ask patients about spiritual concerns and that they do inquire.

19 The fine art of patient-doctor relationships

Goya and Dr Arrieta

The Spanish artist Francisco Goya (1746-1828) has left the most moving testimony of his gratitude for the close relationship with his doctor in Self Portrait with Dr Arrieta (1820). An inscription below the figures explains why Goya made the picture: “Goya, in gratitude to his friend Arrieta: for the compassion and care with which he saved his life during the acute and dangerous illness he suffered towards the end of the year 1819 in his seventy-third year. He painted this in 1820.”

Bellany and Sir Roy Calne

The prolific output of the Scottish painter John Bellany (1942-2013) has resulted in many portraits of his healthcare team. The night before his liver transplant in April 1988 at Addenbrooke’s Hospital, Cambridge, he was busy finishing a painting. Bellany surprised everyone by returning to painting right after his operation.

In Bonjour Professor Calne he revealed his sense of humour. The image was inspired by Gustave Courbet’s painting Bonjour, Monsieur Courbet (1854), in which the proud and healthy looking artist, on the road to Montpellier, is met by his patron and a servant. Bellany has transformed the idea into a hospital scene. He lies in his hospital bed, weak from surgery, staring out at us while behind him stand members of the medical team: his “patron” Sir Roy Calne, Dr Jacobson, and a nurse. Above his head are the words “Bonjour Professor Calne” and under his hand is the inscription: “Thank you All.”

Van Gogh and Drs Cavenaille, Rey, and Gachet

Several diagnoses have been offered to explain Vincent van Gogh’s complex medical history. As a result of his recurrent illnesses he had many encounters with the medical profession, and by the time of his death in 1890 he had painted three doctors. He painted Dr Rey’s portrait in gratitude for the sympathetic treatment he had received and gave it to the doctor. It would seem that Dr Rey may have appreciated the gesture more than the painting itself, for tradition has it that he used it to block a hole in a chicken coop.

Munch and Dr Jacobsen

The Norwegian artist Edvard Munch (1863-1944) entered the Copenhagen psychiatric clinic of Dr Daniel Jacobsen on 3 October 1908. His admission was the result of many years of deteriorating mental health: depression with paranoia, aggravated by alcoholism. During his eight month recuperation at the clinic, he sketched himself receiving nonconvulsive electrotherapy from Jacobsen and his assistant, Miss Schacke. Above the sketch Munch wrote: “Professor Jacobsen is electrifying the famous painter Munch, and is bringing a positive masculine force and a negative feminine force to his fragile brain.”

References
  • 1. Singh H, Meyer AN, Thomas EJ. The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations. BMJ Qual Saf. 2014 Sep;23(9):727-31.
  • 2. Mark L. Graber, Eta S. Berner. Diagnostic Error: Is Overconfidence the Problem? The American Journal of Medicine Volume 121, Issue 5, Supplement, Pages S1-S48 (May 2008)
  • 3. Cadieux G, Tamblyn R, Dauphinee D, Libman M. Predictors of inappropriate antibiotic prescribing among primary care physicians. CMAJ. 2007 Oct 9;177(8):877-83. PubMed
  • 4. Dynamic Competitive Forecasting Model Incorporating Dyadic Decision-Making. Management Science journal.
  • 5. Shelly Reese. Drug Abuse Among Doctors: Easy, Tempting, and Not Uncommon. January 29, 2014
  • 6. DuPont RL, McLellan AT, Carr G, Gendel M, Skipper GE. How are addicted physicians treated? A national survey of Physician Health Programs. J Subst Abuse Treat. 2009 Jul;37(1):1-7. PubMed
  • 7. Morgan MA, Dana J, Loewenstein G, Zinberg S, Schulkin J. Interactions of doctors with the pharmaceutical industry. J Med Ethics. 2006 Oct;32(10):559-63. PubMed
  • 8. Chew LD, O'Young TS, Hazlet TK, Bradley KA, Maynard C, Lessler DS. A physician survey of the effect of drug sample availability on physicians' behavior. J Gen Intern Med. 2000 Jul;15(7):478-83. PubMed
  • 9. Beach MC, Sugarman J, Johnson RL, Arbelaez JJ, Duggan PS, Cooper LA. Do patients treated with dignity report higher satisfaction, adherence, and receipt of preventive care? Ann Fam Med. 2005 Jul-Aug;3(4):331-8. PubMed
  • 10. Rao JK, Anderson LA, Inui TS, Frankel RM. Communication interventions make a difference in conversations between physicians and patients: a systematic review of the evidence. Med Care. 2007 Apr;45(4):340-9. PubMed
  • 11. Makoul G, Zick A, Green M. An evidence-based perspective on greetings in medical encounters. Arch Intern Med. 2007 Jun 11;167(11):1172-6. PubMed
  • 12. Bendapudi NM, Berry LL, Frey KA, Parish JT, Rayburn WL. Patients' perspectives on ideal physician behaviors. Mayo Clin Proc. 2006 Mar;81(3):338-44. PubMed
  • 13. Trilla A, Aymerich M, Lacy AM, Bertran MJ. Phenotypic differences between male physicians, surgeons, and film stars: comparative study. PubMed
  • 14. Tarn DM, Heritage J, Paterniti DA, Hays RD, Kravitz RL, Wenger NS. Physician communication when prescribing new medications. Arch Intern Med. 2006 Sep 25;166(17):1855-62. PubMed
  • 15. Vreeman RC, Carroll AE. Medical myths. BMJ. 2007 Dec 22;335(7633):1288-9.
  • 16. Curlin FA, Sellergren SA, Lantos JD, Chin MH. Physicians' observations and interpretations of the influence of religion and spirituality on health. Arch Intern Med. 2007 Apr 9;167(7):649-54. PubMed
  • 17. Curlin FA, Odell SV, Lawrence RE, Chin MH, Lantos JD, Meador KG, Koenig HG. The relationship between psychiatry and religion among U.S. physicians. Psychiatr Serv. 2007 Sep;58(9):1193-8. PubMed
  • 18. Blendon RJ, Benson JM, Hero JO. Public trust in physicians--U.S. medicine in international perspective. N Engl J Med. 2014 Oct 23;371(17):1570-2.
  • 19. Curlin FA, Lawrence RE, Odell S, Chin MH, Lantos JD, Koenig HG, Meador KG. Religion, spirituality, and medicine: psychiatrists' and other physicians' differing observations, interpretations, and clinical approaches. Am J Psychiatry. 2007 Dec;164(12):1825-31. PubMed
  • 20.

Last updated: February 18, 2016
Created: February 18, 2016

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