Can a Patient-Centered Approach Backfire on Physicians?

Ambulatory surgery centers (ASCs) are known for their quality and convenience of care, with patient satisfaction surveys indicating that healthcare consumers appreciate a more civilized, personalized experience. A greater number of physicians are adopting a patient-centric approach to healthcare delivery, which involves educating patients about their conditions, encouraging questions, discussing how the condition affects the patient emotionally, and involving patients in treatment decisions. Many patients, including baby boomers, enjoy this style of treatment, but new research from the University of Iowa suggests that it isn’t for everyone, and in some cases, patients may be significantly less likely to follow physicians’ orders and feel satisfied with their care.

According to the study, recently published in the Annals of Behavioral Medicine, patients are most satisfied with care and most likely to follow treatment plans — like taking medication or making diet changes — if they see a doctor whose attitudes toward patient-physician roles are in line with their own. Some patients, especially older patients, prefer a doctor with a more traditional doctor-centered or “paternalistic” style, someone who spends less time explaining a condition and seeks little patient input when it comes to treatment decisions. The study showed that when those patients are matched with patient-centered doctors who want them to take an active role, they’re less likely to follow treatment recommendations or feel satisfied with their care.

“There’s a sizable subset of patients with whom the patient-centered approach is going to backfire,” says Alan Christensen, professor of psychology at the University of Iowa. “There are patients who strongly believe it’s the physician’s job to make decisions. If those people are matched with a physician who wants patients to be more engaged, 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.”

Christensen says patients who experience a mismatch between their own expectations and preferences for the medical encounter and what actually transpires during the clinical visit are less likely to follow treatment recommendations because their expectations weren’t met at the appointment. “We know from other research that, in general, when people’s expectations aren’t met, the psychological reaction can be to try to restore control by doing your own thing, or even doing the opposite of what you’re told,” he says.

In the study, highly engaged, patient-centered patients treated by doctor-centered providers who prefer less patient involvement, were moderately satisfied with their care and following doctor’s orders. They did better than doctor-centered patients with patient-centered doctors, but not as well as patients who saw a doctor with attitudes similar to theirs.

“A more passive patient who wants the doctor to take the reins is probably not as adaptable to an unwelcome role,” Christensen says. “Patients who are highly keyed-in to their own care and motivated to take on responsibility will likely find other ways to accomplish that, even when confronted with a provider who is reluctant to share control.”

It’s certainly food for thought. Patients will always want a comforting interaction with their healthcare providers, but perhaps they will always expect that the doctor knows best, and that’s not bad for business. 

Until next month, 

Kelly M. Pyrek 
Group Editor, Virgo Publishing Medical Group 
kpyrek@vpico.com 

Share this article: Email, Slashdot, Digg, Del.icio.us, Yahoo!MyWeb, Windows Live Favorites, Furl
Add this article feed to: RSS, My Yahoo, Newsgator, Bloglines