For Fear of Being “Difficult”, Will I Forego My Needs?

----Terri Bernacchi, PharmD, MBA, Cambria Health Advisory Professionals
A study by the Palo Alto (Calif.) Medical Foundation Research Institute published by Health Affairs this May describes what many of the “meek” already know. You don’t want to irritate your doctor with too many off-putting questions; you’d rather suck it up and trust that he/she will do the right thing. http://newsroom.pamf.org/2012/05/patients-fear-being-labeled-difficult/

Though not a random, large scale trial, the researchers confirmed something many of us who have taken care of patients already know: There is often something broken in the dialogue between physician and patient as it relates to “give and take”.  The patient often withholds information, lies, or deliberately remains quiet when the golden opportunity to ask questions, challenge, or probe for options comes up.  Think how hard it is to ask for a second opinion! 

 In December 2009, PAMF researchers interviewed 48 people broken into six distinct focus groups. The participants were randomly selected from the electronic health records of five primary-care physicians in the San Francisco area.  Maybe not suprisingly, most were white, well-educated and more than 50 years old, and 19 reported annual incomes of $100,000 or more, although the investigators believe the results apply across all demographics.


And I would tend to agree with them from my own anectdotal experience.
The researchers found that focus group participants feared to question a physician’s advice or recommendations, concerned that they would be perceived as a challenge to the doctor’s authority. Most of them wanted to avoid “displeasing” or “disappointing” their physician.

Patient-Doctor Relationships represent a fundamental imbalance in power;  some felt that their physicians perpetuated this authoritarian stereotype. To manage their care, then, many described “doing their own research about treatment options and bringing social support to medical consultations to make the best use of the limited time available.”

“Shared decision-making is a collaborative process that allows patients and their healthcare providers to make health care treatment decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences”: This requires two way exchange of information and implies accountability on both parties to actually be direct with regard to needs, wants and concerns.

It may mean that we should start early (perhaps in grade school) to encourage more effective means to encourage two-way dialogue with health care providers so that the charade of what is actually going on with a patient does not involve the patient withholding important factors or feelings (embarrassment, shame, unworthiness) that could impact care.

Terri is the founder of Cambria Health Advisory Professionals. Among her current clients: a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders. a small special needs health plan as a 5 Star Consultant, and several other health related clients. The thoughts put forth on these postings are not necessarily reflective of the views of her employers or clients nor other Health Advisory Professional colleagues. Terri has had a varied career in health related settings including: 9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago. She has both a BS and a PharmD in Pharmacy and an MBA.