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Often, doctors and patients end up working at cross purposes to each other when neither side understands the others' priorities. In this study, patients were more likely than their doctors to list avoiding insulin and getting off all medications as priorities, whereas physicians were the ones prioritizing lowering blood pressure or cholesterol levels. Although nearly three-quarters of the patients had hypertension, only 15 percent listed blood pressure control as one of their top three treatment goals.

The study authors suggest both patients and physicians need to define and explicitly discuss patient-specific health goals better. In particular, physicians must clarify why treatment recommendations such as lowering blood pressure are important.

"Patients often may disagree with a doctor's priority, but they usually don't share this lack of agreement with their doctor, and instead simply don't implement the recommendation," Heisler says. "Most research suggests that only about one-third of patients follow their doctor's treatment recommendations on a regular basis. To improve these numbers and clinical outcomes, it is critically important that doctors work with their patients to develop a workable treatment plan. The specific problems chosen to give priority to should be based both on their medical importance and the patient's motivation and readiness to address the problem."

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Contact: Nicole Fawcett
nfawcett@umich.edu
734-764-2220
University of Michigan Health System
8-Nov-2003