Communication breakdown: Study finds patients, physicians interpret heart attack risk differently

When physicians and patients talk about the risk of possible heart attack in the emergency room, patients overestimate the risks and benefits of hospital admission, according to a recent study published in the Annals of Emergency Medicine.

The study examined 425 pairs of matched surveys completed by physicians and patients with possible acute coronary syndrome. Respondents answered questions about the perceived and communicated risk of having a future heart attack and the mortality risk of having a future heart attack in the hospital versus at home.

The study revealed the following weak spots in physician-patient communication.

  • 65 percent of patients said they discussed the risk of myocardial infarction with their physician, compared to just 46 percent of physicians.
  • Patients' median estimate of short-term risk was 8 percent, compared to physicians' median estimate of 5 percent.
  • Patients' median estimated risk of death after a heart attack was 80 percent if they were to go home and 10 percent if they stayed in the hospital.
  • Physicians' median estimated risk of patient death was 15 percent at home and 10 percent in the hospital.

The data shows a clear disconnect between the patients' and physicians' perceived risk. According to a corresponding editorial in the Annals of Emergency Medicine, "physicians' risk estimates in this study were grossly inaccurate." The author believes physicians are not using proper prediction models, in addition to poorly communicating risk. Using words such as "low" or "high" leave room for widely varying interpretations of risk.

"Our survey results suggest that patients are often unaware of the primary rationale for their admission to the hospital and that both physicians and patients severely overestimate the risk of adverse events, a factor central to this decision," the authors of the study wrote. Training physicians about risk prediction and communication could help improve decision making in the emergency room, the authors suggest.


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