Questioning the Doctor, Challenging a God

Patients want collaborative relationships with their doctors but fear retribution for raising too many questions.

The Doctor Will See You Now
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How many times have you seen the phrase, "Discuss it with your doctor"? From Internet medical articles to TV ads selling drugs, the phrase continually pops up as if it's the simplest thing the world to do. A team of doctors and researchers who conducted focus groups with patients from the San Francisco Bay area have now published evidence that's all too familiar to people in the rest of the country: discussing medical issues with your doctor is much easier said than done.

Two major concerns mentioned by the patients were fear of losing their doctor's good will by questioning their advice and the lack of time during doctor visits.

One way subjects coped with the lack of time during doctor visits was to do their own research outside of the doctor's office, mainly via the Internet. Some reported that they felt the need to do this covertly. Questioning their doctor during the visit would be rocking the boat.

The researchers selected their study subjects from the patients of five primary care physicians in Palo Alto, California, an affluent suburb of San Francisco. They looked at subjects 40 years of age or older because older patients are more likely to have been involved in making sensitive medical decisions. Forty-eight patients were selected and attended six focus groups.

At the beginning of each focus group session, study subjects watched a short video describing several different treatments for a heart ailment. This was to reinforce the point that many different treatment alternatives may exist for a particular condition. The subjects then described their past experiences and current thoughts on communicating with their doctor about medical options and issues.

They expressed the desire to collaborate with their doctor in making treatment decisions but often found roadblocks in the way. Many felt that questioning the advice or recommendations of their doctor meant questioning their expertise and possibly their authority. They also feared that this might lead to retribution in the form of lower quality treatment from their doctor somewhere down the road.

In the words of one subject: "It would feel very uncomfortable if I were in a position where I felt like I were challenging the doctor, and essentially challenging his authority I would probably do it, but it's not a very comfortable situation..."

That subject also spoke of disagreeing with your doctor as being like challenging a god; usually a very unhealthy behavior.

Subjects also worried that asking too many questions could gain them the reputation of being a difficult patient, which would become part of their personal medical record.

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