A recent survey about patient attitudes and desires with regard to health care demonstrate that respect for scientific evidence is still the dominant factor in preferring treatments. (Full study) This is good news, although the numbers could be better.
Researchers asked subjects what factors were important in determining which treatments they would prefer, the scientific evidence, the experience of the clinician, or their own personal preferences. Not surprisingly, most subjects wanted it all, agreeing that all three are important. Scientific evidence, however, scored the highest with 71% rating it as very important (and over 90% as important or very important). Clinical expertise had 61% strongly supported and personal preference, 57%.
Further, patients wanted their doctors to talk to them about the evidence. The phrase they felt had the most impact on their decision to accept a treatment was, “What is proven to work best.”
All of this matches my personal experience as a clinician. At least for the self-selective population of patients who seek out a university physician, patients tend to find recommendations based upon published evidence compelling, and greatly appreciate when I take the time to tell them about the evidence, even if it goes against their initial interests.
Patients, for example, frequently ask me what I think about acupuncture, a particular supplement, or some other “alternative” treatment for their condition. I tell them – without waffling or watering down my opinion. I don’t editorialize or express judgmentalism because that is inappropriate in a therapeutic context, but I tell them my understanding of the published scientific evidence and the plausibility of the treatment, and then give them my bottom-line recommendation. I do this as if I were talking about any treatment option. Even when patients are starting from a very different opinion about the treatment, they appreciate the fact that I have taken the time to look into the research and to communicate that to them.
This is exactly why the “shruggie” approach to unconventional treatments is counterproductive and a huge disservice to patients. Saying, “I don’t know” when asked about an implausible and ineffective treatment, or even giving a dismissive response, is not going to be convincing to patients.
The survey also found that taking the time to communicate to patients about the scientific evidence greatly improves their satisfaction with their health care – another way in which the dismissive approach has a negative impact.
Despite an ongoing effort by some promoting treatments that are not science-based, there is still huge public support for science in general and science-based treatments. That is why proponents of dubious treatments are so desperate for the trappings of scientific legitimacy, even to the point of rewriting the rules of science to accommodate their preferred treatments. This is turn leads to the need to have watchdog groups defending the role and integrity of science in the practice of medicine.
The bottom line of this survey is that patients respect evidence and want their physicians to talk to them about it, although only 35% reported that their doctors take the time to explain the latest medical evidence. In order to improve this situation physicians need to understand the evidence not only for treatments they use, but also for treatments their patients are likely to ask them about, including CAM therapies.
I need to point out that, like all surveys, this data needs to be taken with a grain of salt. How questions are asked has a significant impact on how they are answered. Also, it would have been interesting to have control questions, asking patients how they feel about treatments that are not based on evidence, or that are based upon tradition or treatments for which a possible mechanism is not understood by science. Would patients accept a treatment that is lacking evidence or even if the evidence indicates it does not work if it were supported by anecdotal evidence? This survey, it can be argued, had a significant bias toward scientific evidence.
Regardless of the limitations, it does draw attention to the need for physicians to engage with individual patients, and, I would argue, the broader society, about the role, methods, and findings of science in medicine.
