A doctor puts his hand over his chest during a ”House call” rally against proposed healthcare reform legislation at the Capitol in Washington November 5, 2009.

Credit: Reuters/Kevin Lamarque

NEW YORK (Reuters Health) – Although most people who participated in a new survey preferred making medical decisions together with their doctor, the majority said they wouldn’t speak up if what they wanted conflicted with their physician’s recommendations.

The findings are based on an online panel of 1,340 adults who were told to imagine they had heart disease and were then asked about how they wanted to be involved in their own treatment.

“We know when patients are surveyed directly they really want to participate in their medical decisions, but are very nervous about this idea of pushing back against doctor recommendations for fear of being labeled a ‘bad patient,’” said Dr. Michael Barry, president of the Informed Medical Decisions Foundation and a primary care doctor at Massachusetts General Hospital in Boston.

Barry, who wasn’t involved in the research but whose foundation funded it, told Reuters Health it’s important for doctors to invite each patient to contribute to medical decisions – instead of believing whatever they would do for themselves is what the patient would also choose.

“It can be really tempting for doctors to think, there’s only one way to go,” he said.

“I think getting over that culture – that there’s a right answer based as a clinician on your preferences – is what we’re facing. Clinicians are the experts in the options and the outcomes of the options, but patients are experts in what’s best for them.”

SOCIALLY UNACCEPTABLE?

Of all the survey participants, close to 70 percent said they preferred making medical decisions together with their doctor, with each contributing equally to treatment calls.

For moderate heart disease, that can include the choice between medications, bypass surgery or angioplasty (inserting a stent) – all of which have similar long-term outcomes but come with different side effects and risks, said Dominick Frosch, from the Palo Alto Medical Foundation Research Institute and the University of California, Los Angeles.

More than 90 percent of people could envision asking their doctor questions and discussing their treatment-related preferences, Frosh and his colleagues found.

Still, just one in seven responders said they would bring up a disagreement with their doctor if the doctor’s recommendation clashed with what they wanted out of their treatment. Some hypothetical patients thought disagreeing wouldn’t be socially acceptable or would negatively affect their relationship with their doctor.

The study was published Monday in the Archives of Internal Medicine.

Frosch said miscommunication between doctors and patients can lead to worse outcomes, for example if patients don’t take their blood pressure medications because they hadn’t wanted drugs to begin with.

If that conversation about treatment options happens earlier, “it’s reasonable to at least expect… perhaps patients would come out of that consultation with decisions they’re more comfortable with,” he said.

Along with heart disease, Frosh said patients recently diagnosed with early breast cancer or prostate cancer often have important decisions to make about treatment options, for example. “For patients, the important thing is, it would be really valuable for them to be able to speak up,” Frosh told Reuters Health.

And for doctors, it comes down to “needing to create a safe space for patients to be able to speak up and express their preferences.”

SOURCE: bit.ly/PM2kaj Archives of Internal Medicine, online July 9, 2012.