Doctor-Patient Dialogue Key To Healthcare Decisions
By Dr. James Palermo // May 23, 2012
(Video by PaloAltoMedical)
According to a study by researchers from the Palo Alto Foundation Research Institute recently published in Health Affairs, patients fail to speak up during physician visits—even when the doctor’s decision could jeopardize their health—for fear of being labeled “difficult.”
Patients Concerned About Straining Their Doctor-Patient Relationship
The research team, led by Dr. Dominick Frosch, an associate staff scientist in the Department of Health Services Research at the Palo Alto Medical Foundation’s Research Institute and an assistant professor of medicine at the University of California, Los Angeles, interviewed 48 patients from various Palo Alto medical practices focusing on patient participation in clinical decision-making and understanding the rationale for reluctance to engage in a collaborative discussion with physicians about their choices in health care.
Study participants clearly articulated their desire to speak up about decisions related to treatment options with their physicians, but often refrained from “asking too many questions” or challenging their physicians for fear of straining the relationship, especially if the physician projected a strong authoritarian demeanor.
In regard to the socio-economic make-up of the study cohort, Dr. Frosch said, “What’s interesting to us is these were mostly Caucasian, highly educated, well-to-do people, and they’re talking about these difficulties. It’s difficult to imagine this is easier for people in a less advantageous social position.”
Lack Of Candid Dialogue May Put Patients In Jeopardy
It is well established that patient participation in their own care by asking questions and providing information to their doctor is an integral element in ensuring high quality, effective and efficient care that results in better outcomes and higher satisfaction. In fact, patients may be putting themselves at risk if they do not speak up.
Addressing the issue of patients “speaking up” about their healthcare, Joanna Smith, CEO of Healthcare Liaison Inc., an organization that assists people of all ages in navigating an increasingly complex healthcare system, said, “Medicine has gotten too complex, and we haven’t given people good tools to understand how to make a complicated medical decision.”
The authors point out that, unfortunately, physicians in many cases may not be aware of the need to nurture a relationship with their patients that provides an atmosphere in which meaningful two-way communication and shared decision-making is encouraged.
Dr. Frosch’s recommendation to physicians is to be very explicit with patients that their opinion is valued, what they have to say is important, and they are expected to be part of the process to decide what to do about their care.
Tactics To Help Ensure Personalized, Effective Healthcare Services
Strategies for patients to ensure personal participation with their caregivers in their healthcare decisions and better articulate their needs during physician visits include:
- Coming prepared with written questions to maximize the physician’s time.
- Candidly expressing any misgiving or discomfort with any recommendation or treatment, rather than independently deciding not to follow physician instructions.
- Determining whether a physician is clearly willing to participate in meaningful two-way communication related to shared decision-making—and if not, seriously considering finding a new physician who will.