Doctors Often Dismiss Concerns About Drug Side Effects: Study

Doctors often dismiss or ignore patient concerns about possible side
effects of prescription drugs, says a University of California, San
Diego study published this week in the journal Drug Safety.

The analysis of 650 patients taking cholesterol-lowering statin drugs
found that 87 percent of patients spoke to their doctors about
possible side effects of the medications. Patients said their concerns
were either dismissed or not addressed 50 percent of the time.

Responses from doctors included: "These drugs have no side effects"
and "You're just getting older." Some patients were told they were
imagining side effects, or they just didn't like taking pills.

The researchers noted that physician monitoring of drug side effects
is essential to ensuring drug safety.

"If doctors don't acknowledge the possible connection of a patient's
symptom to their drug, we are at risk both of missing important safety
information and of having patient care compromised," lead author
Beatrice Golomb, an associate professor of medicine, said in a
prepared statement.
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Physician Response to Patient Reports of Adverse Drug Effects:
Implications For Patient-Targeted Adverse Effect Surveillance

Authors: Golomb, Beatrice A.; McGraw, John J.; Evans, Marcella A.1;
Dimsdale, Joel E.2

Source: Drug Safety, Volume 30, Number 8, 2007 , pp. 669-675(7)

Abstract:

Objective: Using a patient targeted survey, we sought to assess
patient representations of how physicians responded when patients
presented with possible adverse drug reactions (ADRs). As a
demonstration case, we took one widely prescribed drug class, the HMG-
CoA reductase inhibitors (`statins'). This information was used to
assess whether a patient-targeted ADR surveillance approach may
complement provider reporting, potentially fostering identification of
additional patients with possible or probable ADRs.

Methods: A total of 650 adult patients taking statins with self-
reported ADRs completed a survey. Depending on the problems reported,
some patients completed additional surveys specific to the most
commonly cited statin ADRs: muscle, cognitive or neuropathy related.
Patients were asked to report drug, dose, ADR character, time course
of onset with drug, recovery with discontinuation, recurrence with
rechallenge, quality-of-life impact, and interactions with their
physician in relation to the perceived ADR. This paper focuses on
patients' representation of the doctor-patient interaction and
physicians' attribution, when patients report perceived ADRs.

Results: Eighty-seven percent of patients reportedly spoke to their
physician about the possible connection between statin use and their
symptom. Patients reported that they and not the doctor most commonly
initiated the discussion regarding the possible connection of drug to
symptom (98% vs 2% cognition survey, 96% vs 4% neuropathy survey, 86%
vs 14% muscle survey; p < 10−8 for each). Physicians were reportedly
more likely to deny than affirm the possibility of a connection.
Rejection of a possible connection was reported to occur even for
symptoms with strong literature support for a drug connection, and
even in patients for whom the symptom met presumptive literature-based
criteria for probable or definite drug-adverse effect causality.
Assuming that physicians would not likely report ADRs in these
instances, these patient-submitted ADR reports suggest that targeting
patients may boost the yield of ADR reporting systems.

Conclusions: Since low reporting rates are considered to contribute to
delays in identification of ADRs, findings from this study suggest
that additional putative cases may be identified by targeting patients
as reporters, potentially speeding recognition of ADRs.

Affiliations: 1: 1 Department of Medicine, University of California,
San Diego, California, USA 2: 4 Department of Psychiatry, University
of California, San Diego, California, USA