From cbc.ca
Patients who find themselves clamming up during doctor visits may be similar in some way to hostages, a new study suggests.
Frozen in fear and confusion, patients may feel like they're helpless and negotiating for their health, the study authors wrote.
"Hostage bargaining syndrome, where patients feel intimidated by the doctor, is a very real phenomenon that many patients experience, particularly those with a serious disease or in a state of great vulnerability," said lead study author Dr. Leonard Berry of Texas A&M University in College Station.
When Berry and colleagues were looking through sociology research about hostages, they saw a reluctance to challenge authority. "That sounded to us like a lot of patients," he told Reuters Health by phone.
Patients may feel like hostages negotiating for their health, even when doctors actively encourage conversation, Berry added. For example, cancer patients and patients in intensive care units, and their families, may feel powerless and dependent on doctors for the next step of care. The problem may worsen when medical errors or unexpected side effects occur or the patient's condition declines.
"One mother told [us] that when she noticed a subtle change in her child's behaviour, she informed a nurse, who promptly performed a routine set of tests that indicated no cause for concern," the study authors wrote. "But the mother's worry lingered, and she lay awake rehearsing what to say to the consultant in the morning. She feared being perceived as disrespectful of the medical team's expertise, or as demanding and overanxious."
"This story (of a parent whose child is receiving extended inpatient care) could just as easily be that of a 70-year-old man with coronary artery disease who is unsure about the cardiologist's recommendation for surgery but hesitates to question it, or a 27-year-old woman with cancer who does not express her fear of treatment related infertility to her oncologist," they added.
Unlike consumer services such as dining out or attending a concert, where customers may feel able to speak up about bad service, medical services often create a "need" and unequal power balance where the doctor is the authority figure. Patients often hesitate to express concerns, downplay serious questions or worry about being "difficult."
"Patients may not want to risk offending the doctor if they don't agree with the treatment," Berry said.
When hostage bargaining syndrome escalates, patients may feel helpless and see no relief or escape, which can lead to neglect, passive reactions, loneliness and depression.
To combat the problem, Berry and colleagues suggest "shared decision-making," where doctors present options and patients explain their preferences. This often leads to less invasive, less intensive treatments, they say.
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