Why patients who don't agree with you stay silent

Communication in the exam room can get complicated, according to recently published research. Discover why your patients are reluctant to reveal their preferences--and what needs to happen for them to change.

Patients are reluctant to disagree with your recommendations when they prefer a different course of action, a new study suggests. But why are they afraid to speak up?

To find out, researchers in California surveyed 1,340 patients aged 40 years or more who visited a doctor within the past year. Their goal was to “describe patients’ intentions to engage in shared decision-making communication behaviors in response to a hypothetical preference-sensitive clinical scenario,” in this case a treatment for heart disease.

The survey found that 93% of participating patients could see themselves asking their doctors questions, and 94% said they could imagine letting their doctors know what they prefer.

Only 14% of those asked, however, said they would tell their doctors that they disagreed with what a doctor recommended if it differed from the patient’s preferences.

Most of the patients asked (79%) acknowledged that they are capable of disagreeing, although only 14% thought disagreeing with a doctor was socially acceptable, and 15% thought disagreeing with a doctor would result in a good outcome.

Of the study participants who would not disagree with their physicians, 47% said they feared being seen as a difficult patient, 40% thought disagreeing would damage their relationship with their doctor, and 52% worried that disagreeing might interfere with getting the care they wanted.

The authors conclude that patients must be made to feel comfortable about raising objections with their doctors, but a change in attitude and behavior may have to occur first.

Results of the study were published online first in the July issue of the Archives of Internal Medicine.