About one-third of doctors and their patients with diabetes do not see eye-to-eye on which of a patient’s health conditions is most important, according to a survey led by the Medical School.
While both doctors and patients frequently ranked diabetes among their top concerns, 38 percent of doctors ranked hypertension as the most important condition that the patient faced, compared to only 18 percent of patients. Patients also were more likely to prioritize symptoms such as pain and depression.
The findings appear online ahead of print in the Journal of General Internal Medicine and may shed light on why some patients have trouble managing their diabetes.
“If a patient and their doctor do not agree on which health problems should be prioritized, it will be more difficult for them to come up with an effective treatment plan together,” says lead author Dr. Donna Zulman, a Robert Wood Johnson Foundation Clinical Scholar in the Department of Internal Medicine at the Medical School and researcher at the VA Healthcare System in Ann Arbor.
When a diabetic patient visits the doctor, the doctor is often concerned about the patient’s risk of long-term complications from high blood pressure or high blood sugar, problems that could lead to heart attack, stroke and kidney disease. The patient, however, might have more pressing issues, such as back pain or depression.
“Both sets of priorities are valid. We know from previous studies, however, that conditions like pain can interfere with a person’s ability to manage his or her diabetes,” Zulman says. “So putting these types of symptomatic problems on the back-burner might lead to worse outcomes in diabetes and other chronic diseases.”
On average adults with diabetes have at least three other chronic health conditions. It means that their doctors face the challenge of addressing multiple complex conditions in a brief office visit.
Researchers at the Ann Arbor VA Center for Clinical Management Research and U-M surveyed 92 primary care doctors and their nearly 1,200 patients who had diabetes and hypertension. Patients and their providers often agreed on the most important health conditions affecting patients. However, for 28 percent of the patient-provider pairs, the provider’s list of top three priorities for the patient did not include the patient’s top priority. Doctors and patients were significantly less likely to agree if a patient was in poor health.
The study reinforces the need for physicians to pay close attention to patients’ symptomatic conditions, especially in this vulnerable population with multiple chronic diseases, Zulman says.
Additional authors are Dr. Eve Kerr, Dr. Timothy Hofer, Dr. Michele Heisler and Brian Zikmund-Fisher, all of the Department of Internal Medicine and the Ann Arbor VA Center for Clinical Management Research.
