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Editors Selection IGR 12-1

Medical Treatment: Doctor-patient communication and adherence

Comment by Fotis Topouzis on:

25001 Doctor-patient communication in glaucoma care: analysis of videotaped encounters in community-based office practice, Friedman DS; Hahn SR; Quigley HA et al., Ophthalmology, 2009; 116: 2277-2285

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Greece In a two-phase observational cohort study, involving 23 ophthalmologists and 50 glaucoma patients, Friedman et al. (1751) evaluate whether an educational intervention designed to improve communication about adherence to glaucoma treatment would alter communication by physicians. In the first phase presented in this manuscript, doctor-patient communication was evaluated in relation to detection and management of non-adherence. Doctor-patient encounters were audio- and videotaped. After the visit, both parties were asked to complete a questionnaire. Patients also underwent a post-visit patient-centered interview. According to the results, doctor-patient communication was universally physician-centered and was found to be satisfactory by both parties. However, doctors failed to identify most patients who admitted to missing doses. In addition, doctors were misaligned with their patients on important issues such as the role of doctor and patient in decision making and the patients' concern about glaucoma and its treatment.

This is the first study in ophthalmology using videotaped encounters, therefore doctor-patient interaction was possibly more accurately assessed, compared to previous studies, providing new insights in doctor-patient communication. Assessing real communication could provide new potential in improving everyday clinical practice. In this context, it would be important to evaluate whether an educational intervention would change doctor's communication, which is the objective of the second phase of the study. According to the authors, these results are expected to be published soon in another manuscript. Therefore, it is unfortunate that in this manuscript only phase I results are presented. On the other hand, it is unknown whether, and to what extent, effective communication would ultimately have an impact on glaucoma management. In addition, the study has a number of limitations, which are acknowledged in the discussion section. These include, among others, the relatively small sample size, the possible difference in doctors and patients being willing to participate in the study compared to those who were not, limiting generalizability, the possible impact of videotaping in both parties' performance and the use of self-report information to assess adherence. Despite these limitations, the study provides valuable information on doctor-patient communication in ophthalmology.

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