Questioning the Doctor, Challenging a God

By Neil Wagner

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

The Doctor Will See You Now
Alexander Raths/Shutterstock

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.


TDWSYN-Icon.jpg
MORE FROM THE DOCTOR WILL SEE YOU NOW

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.

Many participants reported having to contend with an authoritarian doctor, the type who believed that they knew best. Some patients yielded; others fought, often unsuccessfully.

One factor that came up constantly was the time constraints in today's shorter doctor visits. Many people reported feeling self-conscious about how much of the doctor's time they were taking up when they started to ask questions. Others mentioned how they would have asked more questions during a past visit if the visit had lasted longer.

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. Others felt they had to do their own research because they did not trust their doctor's advice.

One useful tactic described by the study subjects was to bring a companion with you to the doctor's office, in case there are any substantial discussions. The amount of information can be overwhelming, and two heads are better than one at keeping track of the information.

The authors point out that most participants in the study lived in affluent areas and had either graduated from or attended graduate school. People from a more disadvantaged background would likely have an even harder time discussing medical issues with their doctor.

One male subject summed up what he's looking for as follows: "I do not regard my doctor as my savior. What I want them to be is my friendly native guide through this jungle of decisions and a full partner in executing that decision."

That's not the picture the study paints at all. The subject might as well have wished for a pony.

While subjects did describe many unsuccessful attempts at communicating with doctors in their past, much of what the study uncovered was a host of reasons why patients think they cannot communicate with their doctor -- why such attempts will fail. It's not entirely clear whether these are actual barriers or barriers that exist only in patients' minds. In either case, patients clearly feel unable to have the type of discussion they would like to have with their doctor.

How do your experiences stack up with the patient accounts from the study? Were the study subjects doing too much thinking and too little talking to their doctors? Or are the problems they spoke of all too real?

An article on the study appears in Health Affairs.


This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

This article available online at:

http://www.theatlantic.com/health/archive/2012/07/questioning-the-doctor-challenging-a-god/259722/