Physician-Patient Communication Project

Over half of all Americans take dietary supplements (vitamins, minerals, herbal products)
along with their prescription medications. With the economic downturn, dietary supplement
sales have surged, perhaps as a result of people attempting to stave off or delay medical
care. Supplements are generally thought to be harmless, but some can potentially interact
with prescription medications, cause liver or kidney damage, and even adversely affect
surgical outcomes. Those substituting dietary supplements for prescription medications also
may suffer significant adverse consequences. The United States Food and Drug Administration
and the Institute of Medicine recommend that patients considering dietary supplement use
consult their providers. Unfortunately, patients fail to disclose dietary supplement use in
up to two-thirds of outpatient office visits. To improve discussions, it is important to
understand what prompts physicians and patients to communicate about dietary supplements.

The overall objectives of this application are to understand how, when and why physicians
and patients communicate about dietary supplements, and to assess how patients respond to
these discussions. An ethnically diverse group of patients and their physicians will be
surveyed and their office visits will be audio recorded. Audio recordings of the visits will
be used to assess the relationship of patient and physician attitudes and values, and the
physician-patient relationship on dietary supplement discussions. A subset of these patients
and physicians will be interviewed to explore how they made decisions to initiate or forgo
discussions about supplements. They also will be asked questions concerning the necessity of
and responsibility for initiating dietary supplement conversations. Patient responses and
reactions to actual discussions also will be explored. Data from observed and reported
interactions will be compared to provide a deeper understanding of factors related to
disclosure. This project aims to provide a broad understanding of the content of
physician-patient discussions about dietary supplements, and to describe how and why
physician and patient attitudes and opinions affect these discussions. Identification of
mutable factors can result in interventions to increase communication about dietary
supplements, help maintain patient safety, and promote appropriate use of supplements
concurrent with prescription medications.