Here’s your tape

Communication between doctors and patients is an integral part of the doctor-patient relationship. Within the first few encounters, the doctor is likely to have given the patient his diagnosis, the possible treatment options, the associated risks and the long-term outlook. With minor ailments, the amount of information given would be limited. Thus, even if the patient could not recall all the facts, the consequences of ‘forgetting’ these facts would not be crucial. However, if the patient has a serious illness such as cancer, the inability to retain some of the facts / information may lead to undue anxiety and psychological stress. How can we improve information retention by the patient?

Researchers from the University Hospital of Wales, UK, randomized a group of 58 patients, newly diagnosed with oesophageal or gastric cancer, to receive or not to receive an audiotape recording of the consultation when they were informed of the cancer diagnosis (Patient Educ Couns 2008; 72: 218 – 222). These patients were assessed for their ability to retain information given at the consultation and the psychological ill effects of the news. Patients randomized to receive tapes were significantly more likely to retain information than patients who were given the news and information only at consultation. Both controls and patients given tapes did not show any difference in their psychological state. The provision of taped consultation did not adversely affect psychological outcome. In another study from the University of Manitoba, Canada, 425 men newly diagnosed with prostate cancer (Psychooncology 2007; 16: 543 – 552) were randomly assigned to one of 4 consultation groups: (1) standard care control – no taping; (2) consultation audio-taped but no tape given; (3) consultation taped and an audiotape given to patient and (4) consultation audio-taped and patients offered the choice of receiving the tape or not [94 of 98 patients accepted the tape]. The study found that, compared to control patients, patients who received the audiotape reported having been provided with significantly more disease and treatment information in general, more information about treatment alternatives and treatment side-effects.

In situations where patients are told of a bad diagnosis such as cancer, their ability to retain all the relevant information on treatment options, side effects and risks is likely to be adversely affected. These patients are likely to be ‘shell-shocked’ and unable to hear anything beyond the words ‘you have cancer’. Providing an audiotape of the consultation is certainly one way of ensuring that the patient and relatives can replay the information given.

In the East, during consultation, the patient may be more comfortable conversing in a dialect or one language (Mandarin / Bahasa) with the doctor, while the children may be more comfortable conversing in English. Even among the children, some might  be more comfortable to have the information in Mandarin / Bahasa while others would like it in English. Thus, providing an audiotape of the consultation may not solve all information transmission and retention issues. In my practice, at the end of the consultation, I prefer to ask the patient to return in a few days with a family member so that we can go over the diagnosis and discuss the matter again. I also encourage the patient and the accompanying relative / friend to write down any questions that come to mind so that they can ask at the next consultation. Providing an audiotape is certainly an alternative but I do think it is not the same as a face to face discussion with ample time set aside by the doctor just for that purpose.