“Doc, tell me what I need to know”—a doctor's perspective

Short abstract

What information do patients need about medicines? Partnership between health professionals and patients depends, in part, on the provision and exchange of accurate and reliable information about drugs, but who should provide it? We invited contributors to answer the question from the perspectives of patients, clinicians, and the pharmaceutical industry

The most common medical intervention is the prescribing of drugs. In Britain over 80% of the population receives at least one prescription over a five year period.¹ Increased patient involvement in health care, a result of sociopolitical changes,² improves health outcomes.³ Informed decision making by patients and doctors working in partnership towards concordance about treatment requires the ready availability of reliable and understandable information. What should be the sources and formats of this information?

Currently, information on contraindications, side effects, interactions, and dose is provided on patient information inserts within drug packets required by licensing authorities. This is usually produced in minute typeface, is legalistic in wording, and is defensive in tone. Unsurprisingly, patients and doctors often find such information discouraging and unhelpful in determining the balance between risk and benefit.

Drug prescribers and dispensers make variable efforts to discuss drugs with patients. Further information is sometimes available from charities, patient support groups, or the internet. There is little published evidence on patients' actual information requirements, no systematic quality control or tailoring of information for individual patients, and little training for doctors or patients in the necessary communication skills.⁴

Information providers should be aware of ethnic, cultural, sex, and age differences in the information needs of patients, and in their culturally determined interpretation of data. However, it would be wrong to generalise about, or assume, the degree of involvement a particular patient will prefer in treatment decisions. Patients' preferences should be explored when the prescription is introduced, and checked again in subsequent consultations.⁴

The communication of risk in numerical terms is by no means always appropriate or meaningful for patients. Metaphors and examples (such as “It is safer to take this course of drugs than to drive home from the surgery”) may be more appropriate.⁵ Some patients may not want to be given such information and, providing they will not be harmed by that choice, we should respect their wishes. The information we do provide ought not to be limited to the drug prescribed, but should embrace alternative prescriptions and other modes of treatment.

Figure 1.

“Take one of these tablets tonight, Mr Tate, and one more if you wake up tomorrow morning”

The amount and complexity of information must be tailored to the perceived needs of a patient. Access to further information should be facilitated, and patients helped in interpreting the data. The internet has greatly expanded the availability of information, but this is often disjointed, incomplete, apparently conflicting, and not aimed at a general audience. The use of information from the web varies considerably across socioeconomic groups. Therefore, to improve access to information, it should in future be provided in a variety of formats—spoken, written, and pictorial. Such information will need to be available as an adjunct to consultations—by telephone, fax, email, text messaging, and post, as well as on the web. The advent of digital radio and television makes likely the development of a raft of specialised medical broadcast channels.

Prescribing clinicians have a key role in ensuring patients have adequate access to information and helping them to interpret this information. Health services are responsible for ensuring the information exists and is reliable and accessible. Pharmaceutical companies have the greatest repository of data on their drugs, but their impartiality may be questioned. Special interest groups (charities, pressure groups) may have their own drums to beat.

I would like to see the establishment of a specialised and rigorous “information source” independent of both the health service and pharmaceutical industry. It would act as an quality controller for information from a variety of sources—research communities in universities, specialist professional bodies, and pharmaceutical companies. Such a trusted resource could monitor, assess, and interpret the research evidence in each clinical area and become an authoritative, but not exclusive, information provider for clinicians and the public. It could also be invited to develop and test methods for information dissemination.

Clinicians, particularly general practitioners (who often can build on long term relationships with patients), must take a lead in information sharing with patients. There will be understandable concerns about the need for yet more time for yet more clinical tasks. It seems logical, however, to argue that early engagement of patients in decision making about treatment should prevent much subsequent morbidity and confusion and may, even in the short to medium term, save time as well as improve outcomes.