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Patients Avoid Disagreeing With Doctor, May Ignore Advice

Most people are unwilling to contradict their doctor in discussions on medical  treatment, according to a U.S. survey showing that most want a say in treatment  decisions or they may end up not following the advice.

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

"A reluctance, indeed a fear, to disagree appears to be a significant barrier  to shared decision making that is present across all sociodemographic strata,"  wrote Dominick Frosch, from the Palo Alto Medical Foundation Research Institute  and the University of California, Los Angeles.

"Reluctance to express disagreement in the office may correlate with poor  adherence outside the office."

Close to 70 percent said they preferred making medical decisions with their  doctors.

But only one in seven said they would disagree with their doctor over  treatment, some saying it would not be socially acceptable or would damage their  relationship with the doctor.

"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  Michael Barry, president of the informed Medical Decisions Foundation and a  primary care doctor at Massachusetts General Hospital in Boston.

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, he said, "It's  reasonable to at least expect... perhaps patients would come out of that  consultation with decisions they're more comfortable with."

The study was published in the Archives of Internal Medicine.


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