Thursday, July 30, 2009

Fear Top-of-Mind for Patients When Talking to Doctors

Verilogue Study of More Than 20,000 Real-Life Patient-Physician Interactions Reveals Patients' Top Health-Related Fears

Original Post: Verilogue Press Release

New Verilogue Point-of-Practice Report Finds One in Four Doctor's Visits Include Fear Discussions; Uncovers Variations in Physician Response--

Horsham, PA, July 8, 2009 - Issues such as swine flu, peanut butter and cookie batter recalls and rising drug costs have recently inundated the air waves, blogosphere and Twitter updates - giving people plenty to worry about when it comes to their health. But a new study issued today by Verilogue explores the actual fears and concerns patients most frequently discuss in their doctors' offices - and just as importantly, how doctors respond to them.

The review of 23,923 naturally-occurring patient-doctor interactions across 14 specialties over the past 18 months found that one of every four physician office visits includes a discussion about a patient fear. Key findings include:

  • Fear conversations arose around three main themes: diseases/illnesses, medicine side effects and life/social concerns.
  • Fear discussions are most likely to occur in psychiatric, cardiologist and neurologist visits and least likely to occur in allergist and dermatology visits.
  • Primary care physicians tend to be less responsive to and empathetic with patient fears, likely due to the time demands of their practices on average.
  • Males and females were equally as likely to initiate a fear discussion with their physician.
  • Patients in their 20s are "fearless," with the least number of fear discussions across age groups.

"Accessing and analyzing the naturally-occurring dialogue between patients and physicians is the only way to truly understand how physicians respond to what patients are thinking and saying, which, in today's consumer-driven health care environment, is more critical than ever," said Jeff Kozloff, CEO and co-founder of Verilogue. "This analysis is just one in our series of Point-of-Practice studies that show how analyzing real-life patient-physician dialogue empowers all constituencies across the health care chain - pharmaceutical and health care companies as well as practitioners will better understand how to shape their conversations with patients so that information is made more relevant and personalized to unique patient situations and needs, which ultimately leads to improved health care practices and, most importantly, long-term health outcomes."

Better Bedside Manner: PCPs vs. Psychiatrists

Verilogue's data and analysis revealed not only a varying degree of discussion of fears driven by the patient, but also a swing in the type of response these concerns generated from physicians. The most common PCP response was to simply acknowledge the fear statement with a quick "Okay" or "I know," and move on without ever directly confronting the fear or asking for further elaboration. Data showed extremely limited examples in which a PCP directly engaged a patient's fear. In most cases, it was common practice for PCPs to not address patients' concerns, even when fears like "I'm so scared" were repeated.

On the other hand, psychiatrists, which represented the largest category of fear-based discussions, often responded like PCPs with a simple "Okay" or "Right" and then moved on, but unlike PCPs, psychiatrists commonly showed empathy toward patient fears, such as with "Wow. That's hard," or "I'm glad he didn't do that." Psychiatrists were likely to mention the word fear, even though they didn't necessarily ask for further elaboration from the patient regarding that fear.

Enemy Number One: Treatment Side Effects

While the number of conversations around disease/illness and life/social fears fluctuated across therapeutic categories, the level of concerns expressed about medicine side effects remained constant, accounting for approximately 20 percent of all fears expressed by patients during visits with PCPs and/or psychiatrists.
  • Medicine side effects - Generalized fears about taking medications were the most common type of fear expressed by patients in this category, as evident in the following authentic patient statements to their physicians: "I'm scared to take something. Everything has a side effect," and, "I'm so scared. I'm allergic to so many medications."
  • Diseases/illnesses - Encompasses statements such as, "My leg bothers me so much now" and "I'm scared to death of the test." Depression, bipolar disorder and ADHD were the three most common disorders associated with a fear statement.
  • Life/social concerns - From financial woes to relationship issues to life planning, patients shared a wide variety of fears related to their lives outside of the clinical context. For example, "It's more pressing now that I don't have a roommate, and I'm worried about money."
Verilogue's Point-of-Practice Database - This is just one in a series of studies to be released by Verilogue that reveal key insights into the patient-physician interaction, derived from Verilogue's Point-of-Practice Database which consists of more than 30,000 unique physician-patient conversations.

Working with 600 physicians across 50+ therapeutic categories, Verilogue recruits geographically diverse panels of high-prescribing physicians who see a large volume of patients, spend the majority of time in direct patient care and maintain a variety of practice types and/or locations. To gather data, physicians digitally record conversations with a few patients each month, following a double opt-in and HIPAA-compliant research protocol. Along with the recording, physicians provide patient chart information and attitudinal data around the interaction. From this database, Verilogue uses a combination of computer-based analysis and analysis from its team of linguists, statisticians and marketing experts to deliver insights.

For this study, Verilogue examined explicit statements of prominent fears and concerns shared by patients with their physicians across 23,923 in-office physician-patient visits over the past 18 months. These fears and concerns were identified through lexical analyses of transcript data and were reviewed by experts in conversation analysis and interactional linguistics to generate findings and validate interpretations.

For more information about Verilogue, visit
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