Why patients who don't agree with you stay silent

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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.