Patients put doctor relationships above their own health

Study warns that patients don't feel empowered to speak up

Patients fail to speak up during physician visits—even when the doctor's decision could jeopardize their health—for fear of being labeled “difficult,” according to a study published Monday in Health Affairs.

Experts cite importance of shared decision-making

The study reveals patients refrain from “asking too many questions” or challenging their physicians for fear of straining the relationship. Researchers from the Palo Alto Medical Foundation Research Institute interviewed 48 patients from various Palo Alto medical practices.

“What’s interesting to us is these were mostly Caucasian, highly educated, well-to-do people, and they’re talking about these difficulties,” according to lead study author Dominick Frosch. “It’s difficult to imagine this is easier for people in a less advantageous social position.”

Health experts say patients who fail to communicate their needs and questions could be jeopardizing their own health.

“Medicine has gotten too complex, and we haven’t given people good tools to understand how to make a complicated medical decision,” Joanna Smith says, a patient advocate for Healthcare Liaison Inc.

Doctors are at fault as well, according to Dr. Alan Greene, a pediatrics professor at Stanford University School of Medicine and founding president of the Society for Participatory Medicine.

“When we talk about participatory medicine, the biggest challenge often is that [physicians] say ‘I’m already doing that,’ but in reality, that’s not really happening,” Greene says.

Tactics to help patients find their voice

Health experts suggest several strategies to help patients better articulate their needs during physician visits:

Patients should:

  • Come prepared with written questions to maximize the physician's time.
  • Voice their discomfort with any recommendation or treatment, rather than independently decide not to follow physician instruction.
  • Identify whether the physician is unwilling to participate in shared decision-making—and if not, consider finding a doctor who will (Health Affairs study, 5/7 [subscription required]; Colliver, San Francisco Chronicle, 5/7).

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