I like it when things that seem intuitive turn out to be true. A study just published in the Journal of Internal Medicine confirms that when doctors and patients have different ideas about the proper balance of power in their relationship, compliance suffers.
The researchers looked at how well patients with both diabetes and high blood pressure managed their diseases through the prism of their relationships with their doctors. When patients believe that they should have more control over their health than their doctors believe they should, they are less compliant with their medications.
"Frustration is one likely reason for this,” said lead researcher Alan Christensen, Ph.D. “If they're not getting the control they expect or prefer, they become less satisfied with the health care they receive and react to that loss of control by being less likely to follow the doctor's recommendations, including filling refills.” I hear the parents of young children among you grumbling, “they needed a study to figure that out?”
This has important implications for the whole notion of patient-centered care. Christensen puts it well: “There's currently a movement toward patient-centered care, which gives patients the opportunity to be more involved,” he said. “This is often a good thing, but it's also important to remember that one patient's empowerment is another's burden,” he said. "Some patients like to receive a lot of information about their condition and prefer to be a leader or equal partner in making decisions about their health. Others would rather just have the doctor sift through the information and tell them what to do.”
I believe that the important thing is for doctors to ask their patients how active they want to be in their own care. And this meeting of the minds relates to communication styles as well. Oncologist Tom Lynch, MD, the chair of the Schwartz Center’s board of directors, asks his patients how much information they want so he can communicate in a way that is comfortable for them. “There are some patients who like to know all the gory details, statistics, and curves, and there are some patients who like just the broad brushes of what this disease might mean,” he says. “Where do you fall in that group?” he asks new patients.
Have you ever had a doctor ask you that?
The researchers looked at how well patients with both diabetes and high blood pressure managed their diseases through the prism of their relationships with their doctors. When patients believe that they should have more control over their health than their doctors believe they should, they are less compliant with their medications.
"Frustration is one likely reason for this,” said lead researcher Alan Christensen, Ph.D. “If they're not getting the control they expect or prefer, they become less satisfied with the health care they receive and react to that loss of control by being less likely to follow the doctor's recommendations, including filling refills.” I hear the parents of young children among you grumbling, “they needed a study to figure that out?”
This has important implications for the whole notion of patient-centered care. Christensen puts it well: “There's currently a movement toward patient-centered care, which gives patients the opportunity to be more involved,” he said. “This is often a good thing, but it's also important to remember that one patient's empowerment is another's burden,” he said. "Some patients like to receive a lot of information about their condition and prefer to be a leader or equal partner in making decisions about their health. Others would rather just have the doctor sift through the information and tell them what to do.”
I believe that the important thing is for doctors to ask their patients how active they want to be in their own care. And this meeting of the minds relates to communication styles as well. Oncologist Tom Lynch, MD, the chair of the Schwartz Center’s board of directors, asks his patients how much information they want so he can communicate in a way that is comfortable for them. “There are some patients who like to know all the gory details, statistics, and curves, and there are some patients who like just the broad brushes of what this disease might mean,” he says. “Where do you fall in that group?” he asks new patients.
Have you ever had a doctor ask you that?
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6 comments:
Interesting question. No doctor has ever asked how much information I want.
Have there been times when you wanted a doctor to ask what you wanted? Is there anything that prevented you from speaking up?
Thanks for your comment! I look forward to hearing from you.
No, I don't think I ever wanted to be asked. I just wanted the information :)
I have been asked to choose between two treatment options, but wasn't given any information on which to base a decision.
As for speaking up, I've wondered what makes it so hard. I've written a few times about hinderances to speaking up. There's the idea that you shouldn't question authority. Some people are intimidated by perception of difference in status between doctors&patients. Sometimes it might seem like the doctor doesn't care. Sometimes you're tired and just want to go home. Sometime either the patient or the doctor seems rushed, so there's no time to speak up. Sometimes the doctor is a jerk and you don't want to talk to him at all. Sometimes you're too shocked at what you've heard to gather your thoughts together enough to speak up. I have a short Speaking Up series on my blog with more about this.
I've TOLD my doctors that I want all the info I can get about my condition (I have RA) but I've never had any doctor ASK me how much I want. It would be wonderful if all doctors asked their patients that question.
My rheumatologist is very good about answering all my questions and generally tells me how I'm doing, and sometimes explains things without me asking, too. I'm satisfied.
Also, you asked Socks if there was anything that prevented her speaking up to her doc about something. In my case, the fact that he's VERY busy can make me feel that I should curtail my questions. But generally, if it's important to me, I ask, and he answers. He's a good doc. ;o)
Thanks to both Wren and Warm Sock for your comments. You both raise important points. This blog post, written from a physician's perspective, also offers some interesting advice on how to prepare for your doctor's visit:
http://davisliumd.blogspot.com/2010/08/how-to-talk-to-your-doctor-simple-easy.html
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