In our conversation, she listed some possibilities. "Maybe doctors don't want to upset patients. Maybe doctors feel if they tell patients the truth about their prognosis, it's going to cause the patient undue amount of stress. Maybe doctors aren't trained to talk to patients about different truths," Iezzoni says. "Maybe doctors don't feel they have enough time in 10 to 15 minutes to have a complete conversation about a patient's prognosis."
"Patients themselves are going to have different preferences for how open they want doctors to be," she adds. "There are certain patients who may say, ' I don't want to know everything, just tell me what to do, give me the highlights. Then there are those who want to be frank and open and have a complete discussion about what their prognosis is. They want to know everything."
Iezzoni noted the ABIM (American Board of Internal Medicine) Foundation's Charter on Medical Professionalism, published in 2002, urged doctors to be "open and honest" with patients and to disclose medical errors promptly. With this latest survey, it doesn't appear physicians are following the guidelines or standards of communication laid out by the foundation, she conceded.
With the high percentage of defensive medicine practiced, as well as physicians trying to hide potential errors to offset potential malpractice litigation, Iezzoni notes, "We need to do a lot more work from the patient and physician side to get to the point there is more openness and frank discussion about the patient's health and patient's prognosis."
"Patients need to feel comfortable going into the doctor's office, and saying, 'Look I want to have a conversation about how I want you to talk to me about my health.'"
Engaging in that conversation with complete honesty could be a first step toward avoiding a malpractice suit.