A recent article in the New York Times titled “Afraid to Speak Up at the Doctor’s Office,” describes the fear and discomfort that some patients experience in the physician’s office when it comes to openly discussing their medical condition and questioning their physician.
The author of the article, Pauline Chen, M.D., describes her phone conversation with an accomplished acquaintance who inquired about the latest research and treatments regarding her specific health condition. Doctor Chen noticed, after encouraging her friend to consult her primary care physician regarding her medical situation, that the tone in her voice seemed less assured. This seemed odd for such a self-assured woman. The woman responded with, “I don’t really feel comfortable bringing it up.” “I don’t want him to think I’m questioning his judgment.” “I don’t want to upset him or make him angry at me!” Does this reaction resonate with you?
A study published in the most recent issue of Health Affairs has tapped into the patient’s perspective to uncover the underlying causes of this unwillingness to speak openly to one’s physician. Researchers conducted several focus groups with 48 patients from five primary care physicians in the San Francisco Bay area. The results show that this common experience amongst patients can be related to the fact that many patients “feel limited, almost trapped into certain ways of speaking with their doctors.” Many felt that their doctors acted “authoritarian, rather than authoritative.” Others within the group spoke of a fear that they would anger their doctors “who knew best.”
To combat patient discomfort, over the last generation, there has been a move toward doctors and patients making a “shared-decision” regarding the patient’s treatment. The move toward a different form of decision making aims to give patients the voice that they often feel they lack when visiting their physician. In the New York Times article, Dominick L. Frosch, lead author of the new study and an associate investigator in the Department of Health Services Research at the Palo Alto Medical Foundation Research Institute in California, says that “Many physicians say they are already doing shared decision-making, but patients still don’t perceive the relationship as a partnership.” Frosch continues by saying: “We urgently need support of shared decision-making. That is more than just rhetoric. It may take a little longer to talk through decisions and disagreements; but if we empower patients to make informed choices, we will all do much better in the long run.”
What do you think? Has the talk of shared decision making been just a lot of talk, or have we made real progress? Are we gradually leaving behind the era of the authoritarian physician? Do patients today feel empowered and are they willing to challenge their physicians? For more information, click here.
(Post written by Dan Dunlop with Charles Ramsey, Jennings Healthcare Marketing Intern and Wake Forest University student)