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The Balance of Power Between Patient and Doctor

Posted Oct 11 2010 8:55pm

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?
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