Monday, November 12, 2012

Patients Hesitate to Disagree

Patients don’t want to disagree with their doctors, even though they would like a say in treatment decisions, according to a survey published in the Archives of Internal Medicine, July 9, 2012.

When asked, more than 9 out of 10 people said they could visualize asking questions and discussing preferences with their doctors, and 80% said they had the ability to disagree.  But when it came down to it, only 14% of patients reported that they would actually challenge their doctor if he or she recommended a treatment that conflicted with their preferences.

Nearly half of those unwilling to disagree feared being labeled as “difficult”; 40% worried such actions would damage their relationship with the physician; and more than half thought disagreeing with their doctor might negatively affect their care.

The online research involved 1,340 adults who were told to imagine that they had heart disease.  They were then asked the extent to which they would like to be involved in their treatment decisions.  The treatments might include options such as medications, bypass surgery or angioplasty—which have similar long-term outcomes, said Dominick Frosch, from the Palo Alto Medical Foundation Research Institute and the University of California, Los Angeles.

Nearly 70% of the survey participants said they preferred making medical decisions together with their doctor, each contributing equally to decisions about treatment.

“We know when patients are surveyed directly they really want to participate in their medical decisions, but are very nervous about this idea of pushing back against doctor recommendations for fear of being labeled a ‘bad patient,’” said Dr. Michael Barry, president of the Informed Medical Decisions Foundation and a primary care doctor at Massachusetts General Hospital in Boston. 

Barry did not participate in the research but his foundation financed it. “I think getting over that culture—that there’s a right answer based as a clinician on your preferences—is what we’re facing. Clinicians are the experts in the options and the outcomes of the options, but patients are experts in what’s best for them.”

Despite current focus on patient-centered care, the authors found that these fears prevent shared decision making.  They noted that poor communication itself can cause inferior outcomes.   A study published in July, 2012 in the journal Perspectives on Psychological Science reinforced this with findings that patients’ feelings of autonomy, competence and relatedness were associated with better mental and physical health.

Frosch cited patients who won’t take their hypertension medication because they didn’t want it in the first place as an example of miscommunication that can lead to worse outcomes.  Frosch said that when it comes to doctors they need to “create a safe space for patients to be able to speak up and express their preferences.” 

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 25.  To download this issue in PDF format, or past issues, visit our newsletter archives online at

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