Patients today want to be more involved in care

There was a time when most patients took the passenger seat and let doctors steer the direction of care. What physicians decided, patients followed.

But that has changed as more patients seek greater access to medical information via the Internet and educate themselves about medical choices before they see their doctors.

Some patients and doctors have formed partnerships in the decision-making process, leaving behind the paternalistic approach.

Two new studies show that many patients and family members support this collaboration.

A Seattle study said 86% of parents participated in medical decisions concerning their hospitalized child. Parents who were confident communicating with physicians were more likely to participate in decision-making.

Meanwhile, an Iowa survey found that patients with similar attitudes as their physicians toward patient-doctor roles were more satisfied with care and more likely to follow treatment. Thus, patients who were involved in decisions were satisfied and followed treatment when they saw doctors who wanted them involved.

"Clearly, there are some patients who want to be empowered in that way," said Alan J. Christensen, PhD, professor in the Dept. of Internal Medicine at the University of Iowa and senior scientist at the Iowa City VA Health Care System.

Dr. Christensen and other Iowa researchers surveyed 16 primary care physicians and 146 patients at the University of Iowa Hospitals and Clinics to gauge attitudes on patient and physician roles in health care.

Patient satisfaction and adherence to treatment were highest when patients and physicians had the same attitudes on such roles, according to the study, published in a recent Annals of Behavioral Medicine.

Patients who wanted a patient-centered approach did well with doctors who practiced patient-centered care. Likewise, patients who wanted the doctor to take charge and make decisions with little input from them fared well with physicians of the same mind-set, Dr. Christensen said.

But patient satisfaction and adherence were poorest when a patient-centered doctor saw a patient who wanted the paternalistic-style physician.

"Patients actually vary to the degree to which they want a patient-centered model. There are some patients who don't want as active of a role," said study co-author Gary E. Rosenthal, MD, director of the Center for Research in the Implementation of Innovative Strategies in Practice at the Iowa City VA Medical Center and a professor of internal medicine at the University of Iowa.

"It's probably good for physicians to get a handle on how active [patients] want to be in decision-making," Dr. Rosenthal said.

The study on parental decision-making was published in the October Journal of Pediatrics and was based on a survey of 130 parents whose children were admitted to Children's Hospital & Regional Medical Center in Seattle in 2005. Younger parents and parents of previously hospitalized children were more likely to take part in decisions, said lead author Beth Tarini, MD, now a clinical lecturer in the Division of Pediatrics at the University of Michigan C.S. Mott Children's Hospital.

Trend toward patient involvement

The studies' findings come as some physician organizations work to make patient-centered care a key part of medical care.

In March, the American Academy of Family Physicians, American College of Physicians, American Academy of Pediatrics and American Osteopathic Assn. issued joint principles of a patient-centered medical home. Those principles include having patients participate in decision-making and seeking feedback to ensure their expectations are met.

"There's much more emphasis on trying to work as a team and less as a paternalistic role in which the physician is all-knowing and tells patients what to do," said AAFP board Chair Rick Kellerman, MD, who practices in Wichita, Kan.

American Medical Association policy supports "the concept of partnerships between primary care physicians and patients to coordinate access to all needed medical services and consultations (a 'medical home') for all patients."

ACP President David Dale, MD, said physicians should determine if a patient wants a patient-centered or paternalistic approach. And that usually comes with time.

"Patients differ," he said. "Good physicians learn to adapt to that."