Clinical Decisionmaking

Doctors and patients need to ask each other more questions about medications

Doctors tend to ask patients questions about their medications that don't elicit comments from the patient, according to a study supported by the Agency for Healthcare Research and Quality (HS08431). The study also revealed that nearly half of patients taking one or more medications for chronic disease did not ask their doctors any questions about these medications.

Previous research has shown that patients are reluctant to ask questions about medications during visits because they fear their physicians' reactions. This study found that physicians perceive question-asking in a positive light. Patients who asked medication-related questions were rated by their physicians as more interested and assertive—but not more irritated or angry—than patients who did not ask questions.

In this study, only 1 percent of medication questions asked by doctors were open-ended. Nearly half of patients were not asked any questions by their doctor about how their medications were helping, and two-thirds were not questioned about side effects or barriers to taking medications. Also, physicians rarely asked about contraindications, allergies, or interactions with other drugs the patient was taking. Physicians are more likely to detect and prevent problems with continued medications and improve patient compliance if they ask patients how the medications are working and whether they have any side effects, suggests Betsy Sleath, Ph.D., of the University of North Carolina at Chapel Hill School of Pharmacy.

Dr. Sleath and her colleagues analyzed 467 audiotapes and transcripts of outpatient visits and postvisit interviews with chronic disease patients and their primary care doctors. All patients took at least one prescribed medication and were using an average of nearly four continued medications. The tapes revealed that physicians and patients spent an average of 4 minutes (20 percent of each medical visit) discussing medications. Doctors asked patients an average of 9.3 questions about medications during each visit. They asked significantly more questions of minority patients, lower income patients, and patients using more continued medications.

For the patients who asked questions about medications (just over 50 percent of those taking at least one drug), the average number of drug-related questions was 2.4. Starting a new medication doubled a patient's likelihood of asking a question.

For details, see "Asking questions about medication: Analysis of physician-patient interactions and physician perceptions," by Dr. Sleath, Debra Roter, Dr.P.H., Betty Chewning, Ph.D., and Bonnie Svarstad, Ph.D., in Medical Care 37(11), pp. 1169-1173, 1999.

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