Healthcare News & Insights

Why do clinicians downgrade patient complaints about meds?

Doctors probably don’t want to hear it, but when it comes to some things — like symptom reporting — patients know best.

That’s the conclusion one doctor came to. He compared how patients on a new medication reported their symptoms and side effects to the way doctors and nurses recorded the patients’ complaints.

Oncologist Dr. Ethan Basch compared symptom reports of patients undergoing chemotherapy. For every side effect, patients reported symptoms earlier and more often than the clinicians did.

The reporting bias is even more exaggerated in drug studies since the information goes through more hands and stages — collection, data input, analysis and evaluation. At each stage it’s possible for a researcher to add his or her own unique spin to what the data “really” means.

Dr. Basch said there’s no clear explanation for why that’s the case, but he offered a few theories:

  • Downgrading patient symptoms could be wishful thinking on the part of doctors and nurses who believe a medication should work.
  • Minimizing the severity of symptoms may be done (subconsciously or not) to avoid creating a potential problem in a patient’s care that needs to be addressed — or that could even lead to a lawsuit.
  • Doctors’ and nurses’ opinions may simply reflect their own biases about how effective a drug is, how well a particular patient tolerates pain/fatigue, etc.

That’s not to say that doctors’ and nurses’ observations of patients’ symptoms aren’t useful — they are. Basch suggested symptom reports might be more accurate and informative if they were reported in two ways: The clinician’s assessment of patient symptoms and side effects, as well as a separate ranking of patient-reported side effects.

Basch’s article appears in the New England Journal of Medicine.

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