Cape Gazette
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People's Pharmacy

Patients afraid to disagree

By Joe and Teresa Graedon | Oct 25, 2012

No sensible person would buy a new car based on the salesman's say-so alone. Most people do some homework, check ratings and mileage, and look under the hood.

When the time comes to do the deal, buyers know that they need to negotiate to get a good price. It may involve some wrangling to achieve a satisfactory agreement.

In the doctor's office, however, otherwise confident people frequently become timid. They both respect and fear the physician and have a hard time negotiating treatment options. That's the conclusion from a study published in the Archives of Internal Medicine (Aug. 13/27, 2012).

The researchers recruited 1,340 people between 40 and 60 years old for an online study. The volunteers were presented with a hypothetical scenario in which they were supposed to make a decision about treating a heart condition. In this scenario, as frequently happens in real life, there is no single best treatment based on evidence, so the patient's preferences should be taken into consideration.

The investigators found that most of these well-educated study subjects had no problem asking questions or discussing their preferences. A majority of them (70 percent) said they thought decisions about treatment were best when the doctor and the patient approached them together.

When it came to expressing preferences that disagreed with the doctor's recommendation, however, only 14 percent said they would do so. The rest were afraid that disagreeing would damage their relationship with the doctor, get them labeled as a "difficult patient" or keep them from getting the care they needed.

This fear of disagreeing with the doctor prevents honest communication and shared decision-making. This may mean that a patient could get a prescription for a drug that worries her. If she doesn't buy in to the treatment plan, she may not follow through with the medicine.

One reader complained: "I cannot believe my doctor put me on lisinopril for my high blood pressure when I am sure he knew the side effects. Within a few weeks of starting, I told him I had a terrible tickle in my throat. After several months, the tickle turned into a horrible cough. It messed up my life: I am afraid to go anywhere for fear of having a coughing attack. Since it keeps me awake at night, I am constantly tired. I stopped taking the pills two weeks ago but I am still retching with this horrendous cough."

ACE inhibitor blood pressure medicines like lisinopril can often cause a cough. The doctor can't predict ahead of time which patients will experience this side effect, but he or she should warn about this complication and be ready to respond if a patient reports trouble. Stopping blood pressure medicine without the doctor's knowledge and help can be risky.

We wrote Top Screwups Doctors Make and How to Avoid Them (PeoplesPharmacy.com) to help people formulate appropriate questions about diagnosis and treatment. In it you will find tips and strategies to help you negotiate the best treatment for your loved one or yourself.

Many people are more assertive in a car dealership than the doctor's office. Choosing an automobile is not a life or death decision. Determining the most appropriate treatment for a medical condition can have life-changing consequences.

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