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Doctors Interrupt Too Quickly, Listen Too Little

January 25, 1999|THOMAS H. MAUGH III

If you've ever thought your physician doesn't take enough time to listen to you, you were probably right. And it is not the fault of time pressures imposed in recent years by HMOs. In fact, physician listening time has improved slightly since the early 1980s, but it is still low.

On average, physicians listen to patients' concerns for about 23 seconds before interrupting them and starting to ask questions, according to a report in Wednesday's Journal of the American Medical Assn. That's about five seconds better than in earlier studies, but it is still short enough that as many as a quarter of patients never get a chance to express their most serious concerns.

And in most cases, says Dr. Howard B. Beckman of the University of Rochester Medical Center, the patients could have gotten out all their concerns if the doctors had waited only six more seconds before starting to ask questions.

Beckman and his colleagues performed the first such study in the 1980s, but the results were criticized because they considered mainly internists in cities and only 74 patients were included. In the new study, his team monitored 300 patient visits to family physicians in cities, rural Washington state and semirural Colorado.

Interviews with patients were taped and transcribed with permission of patients and doctors.

Other studies have shown that patients have an average of three concerns when they visit a physician. Beckman reports that physicians usually interrupted after the first one was expressed, and many patients did not bring up others.

The team called on medical schools to provide physicians-to-be with more training in conducting such opening interviews. They found that 44% of physicians who had received such training allowed patients to express all their concerns, compared to only 22% of those without the training.

Diet Drug Orlistat Shows Promise in Recent Study

A new diet drug that has no effect on the brain can help the obese lose weight and maintain the loss, according to another study in the Journal of the American Medical Assn.

The drug, called orlistat, blocks absorption of dietary fats in the intestine, causing about one-third of the fats to pass through and be excreted. (Use of the fat substitute olestra in potato chips and other foods is based on a similar principle, but in that case, the fat itself is chemically modified so that it passes through the body without being digested.)

A team at 18 medical centers, including UCLA, studied 668 adults who received orlistat and a low-calorie diet and 224 who received the diet and a placebo. The team followed them for two years in the largest and longest study of a weight-loss drug.

During the first year, 65.7% of the subjects receiving the drug lost more than 5% of their body weight, compared to 43.6% of those who received a placebo. During the second year, which was focused on maintenance of the weight loss, patients receiving the drug regained only 32% of their weight loss, compared to 63.4% among those on the placebo.

Hoffmann-La Roche, the drug's developer, said on Tuesday that it had presented the Food and Drug Administration with data on studies with 3,800 more patients to support its application for approval. That approval is expected to be granted this year.

The main side effect of the drug was gastrointestinal distress. The drug also might interfere with the uptake of vitamins A and E.

Patients Aren't Truthful in Blood Pressure Tests

Many patients who monitor their hypertension at home report lower values to their doctors than they actually observed, according to a study in the recently released December issue of the American Journal of Hypertension. Such cheating can make doctors think the patients' health is better than it really is and increase the patients' risk of heart attack and stroke, say researchers from the University Clinic of Bonn in West Germany.

Dr. Thomas Mengden and his colleagues studied 30 hypertension patients who, as part of their normal therapy, were given a sphygmomanometer and told to measure their blood pressure in the morning and evening and record it. They were not told that the devices contained a microchip that stored the pressure information.

Nineteen of the 30 omitted readings and added phantom values to their logbook entries, the researchers reported, entering values they thought the physicians would like to see. In an accompanying editorial, Dr. Lawrence R. Krakoff, a deputy editor of the journal, wrote that "self-reported blood pressures cannot be given credence" and that "past studies using this method are now suspect."

Proper Therapy for Heart Failure Patients Lacking

The vast majority of patients suffering from heart failure, also known as congestive heart failure or CHF, are not receiving the best available therapy, according to new treatment guidelines published Thursday in the American Journal of Cardiology.

An estimated 5 million Americans now have CHF, a syndrome that occurs when the heart has difficulty pumping enough blood throughout the body, and at least 400,000 develop it each year. Some 250,000 people die of it annually. Among people older than 55, the number of hospitalizations for CHF each year is more than twice the number for all cancers combined.

Long-used guidelines call for treatment with digoxin and diuretics, which control symptoms but do nothing to retard progression of the disease. Updated guidelines released earlier this decade called for the addition of so-called ACE inhibitors to the drug regimen, but only about 40% of patients now receive them.

The new guidelines, developed over the past 18 months by a team of 150 cardiologists, call for the addition of a fourth family of drugs, called beta-blockers. Only about 5% of CHF patients now receive these drugs, the group said. Combined, the ACE inhibitors and beta-blockers largely halt the progression of the disease.

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