September 6, 2017 / 4:07 PM / a year ago

Intimidated patients may act like hostages

(Reuters Health) - Patients who find themselves “clamming up” during doctor visits may be similar in some way to hostages, a new study suggests.

Signs directing patients and staff are shown at a hospital in San Diego, California, U.S., April 17, 2017. REUTERS/Mike Blake

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 behavior, 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.

“We’ve brought the elephant into the room that no one wants to talk about and given that elephant a name,” Berry said. “The purpose isn’t to be critical of doctors . . . but to be aware and nip the problem in the bud.”

To build trust, doctors should demonstrate compassion, maintain patient privacy, have good communication skills and show interest in the patient as a person, the authors say. Body language and physical stance, such as sitting rather than standing in front of a patient, signal that the doctor values what the patient says.

At the same time, “physicians could easily react against this ‘hostage’ terminology,” said Dr. Kathy Mazor of Meyers Primary Care Institute in Worcester, Massachusetts, who studies patient-doctor relationships but wasn’t involved in this research.

Patients should be encouraged and empowered to be more active in their health care, Mazor told Reuters Health by phone. Doctors also need support at the organizational level so they can give patients the time to talk and record visits correctly in electronic health records, she added.

“When there are only so many hours in a day, we have to think about how organizations support both patients in speaking up and doctors in giving them what it takes to deliver good care,” she said. “If you make it harder and harder, something is going to give, and we don’t want that to affect the patients.”

SOURCE: Mayo Clinic Proceedings, online August 23, 2017.

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