ABSTRACT
BACKGROUND AND OBJECTIVES: Physicians routinely discuss adverse effects of medications, but whether discussions match older patients' desire for information is unexplored. This study compares patient preferences for adverse effect discussions with reported physician practice. METHODS: Cross-sectional survey of a convenience sample of 100 practicing primary care physicians from 9 medical groups and 178 patients recruited from 11 senior centers in the Los Angeles metropolitan area. Physicians listed the adverse effects they typically discuss when prescribing an ACE inhibitor. Patients were given a hypothetical scenario about a new medication prescription, and were asked to circle the three adverse effects they most wanted to hear about from a list. RESULTS: More than 90 % of patients wanted a physician to discuss medication adverse effects: they wanted information about both dangerous (75 % of patients) and common (66 % of patients) adverse effects. However, patients most commonly chose to hear about adverse effects occurring for < 1 % of patients and selected a wide range of adverse effects for discussion. Physicians reported most frequently educating patients about more common and life-threatening adverse effects. Patients who wanted to discuss more adverse effects were more worried about adverse effects than those wishing to hear fewer (4.0 vs. 3.4 on a 5-point Likert scale; p = 0.02). CONCLUSIONS: For the studied medication, there was little concordance between the medication adverse effects physicians say they discuss and what patients want to hear. Physicians cannot practically verbally satisfy patients' information desires about the adverse effects of new medications during time-compressed office visits. Innovative solutions are needed.
ABSTRACT
These are historic times for family medicine. The profession is moving beyond the visionary blueprint of the Future of Family Medicine (FFM) report while working to harness the momentum created by the FFM movement. Preparing for, and leading through, the next transformative wave of change (FFM version 2.0) will require the engagement of multigenerational and multidisciplinary visionaries who bring wisdom from diverse experiences. Active group reflection on the past will potentiate the collective work being done to best chart the future. Historical competency is critically important for family medicine's future. This article describes the historical context of the development and launch of the FFM report, emphasizing the professional activism that preceded and followed it. This article is intended to spark intergenerational dialog by providing a multigenerational reflection on the history of FFM and the evolution that has occurred in family medicine over the past decade. Such intergenerational conversations enable our elders to share wisdom with our youth, while allowing our discipline to visualize history through the eyes of future generations.
Subject(s)
Family Practice/trends , Primary Health Care/trendsSubject(s)
Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Internet , Patient Care Team/organization & administration , Patient Care Team/trends , Patient Participation/trends , Self Care/trends , Consumer Health Information/organization & administration , Consumer Health Information/trends , Forecasting , Humans , United StatesSubject(s)
Delivery of Health Care/methods , Family Practice , Health Care Reform , Primary Health Care , HumansABSTRACT
Ian McWhinney, MD, who passed away 1 year ago this month, was a founder of family medicine in North America. As a social philosopher and a naturalist, he had a great influence on the development of family medicine.
