While studying for a certification exam, I came across a question that stayed with me well after taking the practice test. The case discussed a patient who was prescribed antibiotics by his physician for a presumed bacterial illness and then returned the following week with an antibiotic-associated diarrheal infection. The test question then asked what could be concluded from this case. The answer: informed consent (i.e., patient permission for a medical intervention) was not properly obtained because the risks of the antibiotics were not completely discussed between the physician and patient.
This nasty diarrheal infection that can develop after antibiotic treatment is not an unheard-of side effect, but it certainly isn't the most common or most serious ailment that plagues this class of medications. Most drug profiles, including most antibiotics, involve dozens of potential side effects, covering a wide range of common to uncommon and bothersome to life-threatening reactions.
Given the wide array of adverse reactions that can potentially occur from taking medications, how much time should be spent discussing these side effects at the doctor's office? Which possible reactions should be emphasized and which should be deferred?
The few research articles I found regarding physician behavior in communicating medication side effects all lead to one common conclusion: We aren't good at it.
For example, a 2006 observational study
by Derjung Tarn, MD, PhD, and her collaborators, published in JAMA Internal Medicine, found that only 35 percent of an observed 235 physicians-patient encounters included any discussion regarding the side effects of newly prescribed medications.
To some, this low percentage in this small study may seem ghastly; certainly the "first, do no harm" mantra that pervades our medical training should apply to prescribing potentially caustic treatments.
But how practical is it to effectively communicate side effects of a new medication during a patient visit that encompasses several other time-compressed facets of medical care? And how does one define a "sufficient" discussion when there are several potential side effects with varying harm for each medication?
Given the importance of this conversation and the extent of these discussions (patients certainly should have space to ask questions), the medical field must ask itself the following:
- How can clinicians better and more efficiently communicate medication side effects to patients receiving new prescriptions?
- What ways can clinicians, pharmacists, and patients work together in improving patient education and reducing medication-related harm?
- What are the explicit expectations of each of these stakeholders and how can we better train the medical community to reach them?
For now, the discussion of medication side effects between clinician and patient remains an elusive and undefined practice. Given the potential harms of prescription drugs, we must consider ways to improve this dialogue to better enhance patient safety and education in ways that also work within the time-constraints of a robust medical practice.
Originally written for LeadDoc