Patients avoid disagreeing with doctor, may ignore advice

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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."