More threads by David Baxter PhD

David Baxter PhD

Late Founder
Some Patients Want Physicians to Make All the Decisions

NEW YORK (Reuters Health) Aug 23 - Not all patients want an active role in their health care and medical decision-making, according to a study reported in the August issue of the Annals of Behavioral Medicine. In some cases, therefore, a patient-centered approach to healthcare can be counterproductive.

"There's really a sizable subset of patients with whom the patient-centered approach is going to backfire," Dr. Alan Christensen says in a University of Iowa news release. "There are patients who strongly believe it's the physician's job to make decisions."

To examine the mind-set of physicians and their patients and how well they match, Dr. Christensen's group surveyed 16 primary care physicians at the University of Iowa Carver College of Medicine in Iowa City, and 146 of their patients. Their goal was to examine "the similarity of the attitudes held by patients and their physicians (symmetry) about the patient role in health care delivery and its relationship to patient outcomes."

The investigators assessed patient and physician preferences regarding the patient-physician relationship and the role of the patients in health care delivery using the multidimensional HLOC (Health Locus of Control) scale Form A-Internal subscale.

Patients were also asked to rate their satisfaction with their present physician and their healthcare, as well as their adherence to medical recommendations.

Dr. Christensen's team categorized patient-physician dyads into three groups: asymmetrical dyads in which patients were less patient-centered than their physicians, asymmetrical dyads in which patients were more patient-centered than their physicians, and symmetrical dyads.

When patients did not want an active role, but their physician wanted to involve patients more and to share decision-making, patients were significantly less adherent and less satisfied, the report indicates.

In contrast, patients who were more patient-centered did not differ significantly in terms of adherence or satisfaction, compared with patients in symmetrical dyads.

In the latter situation, patients who are motivated to take responsibility for their own health will find ways to do so "even when confronted with a provider who is reluctant to share control," explains Dr. Christensen in the university statement. On the other hand, "A more passive patient who wants the doctor to take the reins is probably not as adaptable to an unwelcome role."

In that case, he adds, "the physician could end up putting too much responsibility on the patient's shoulders and not giving them enough direction. So they leave the appointment feeling confused about what they're supposed to do, or with information overload."

Ann Behav Med 2007;33:262-268.


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It can be a fine line when it comes to care. And depends where the client is at. I know for myself that I don't do therapy groups because I am too easily triggered. I definitely stay away from ones that are in hospitals or institutionalized setting because of my background.

I want my doctor and therapist to know what they are doing as I am there for assistance. However, its my opinion that a goal would be to pass on more control to the client as it builds self-confidence and they are the only ones that live there own lives.

And what works for one person may not work for someone else (I have personal experience with that) so the client is the ultimate decision maker.

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