Involved patients not always the healthiest

Feb 22 2008

Patients who say they want to take an active role in their health care could be unhealthier in some respects than patients who prefer to let their doctors lead the way, according to new research published in the Annals of Behavioral Medicine.

In a study of 189 patients treated at two Veterans Affairs Medical Centers and four community clinics, those who said patients and doctors should be on a more equal footing when it came to treatment decisions had higher blood pressure and cholesterol scores than their peers.

The study raises questions about whether some patients are being as proactive about their health as they say would like to be, and whether being a more active participant actually translates to better health, said Austin Baldwin, Ph.D., of the Iowa City VA Medical Center and colleagues.

The current study suggests, “It's not a one-size-fits-all approach,” Baldwin said.

So far, there are few studies to answer these questions, according to Baldwin. On one hand, some evidence suggests that patients who want to participate more actively in their health care do better at managing chronic conditions like diabetes and high blood pressure.

Still other studies have found that people who want a more patient-centered type of care are “less satisfied with their care, less trusting of their physician and less likely to endorse their physician to others,” Baldwin said.

In the study, Baldwin and colleagues gave out questionnaires to patients waiting for treatment to determine their preferences for patient-centered care. The participants rated how strongly they felt about statements like, “The doctor is the one who should decide what gets talked about during a visit.”

Patients who felt strongly about having some control over their health care were more likely than others were to seek out health information on the Internet and from multiple sources, the researchers found.

While blood pressure and cholesterol scores were higher among those who wanted more patient-centered care, they did not have significantly higher blood glucose scores than the other patients. This could mean that even though the patients said they wanted to be more active in their care, they had a harder time controlling “asymptomatic conditions” like high blood pressure, Baldwin said.

It is also possible that the people who preferred more patient-centered care disagreed with their doctors on how active of a role they should play. Recent studies show that when patients and doctors agree on care, it can “result in a more satisfying health care experience and better health outcomes,” Baldwin said.

Nevertheless, physicians should not abdicate their own active roles, especially when patients seem to be swayed by direct marketing of medical treatments that might not be a good fit for their conditions, said J. Bohannon Mason, M.D., of the OrthoCarolina Hip and Knee Center in Charlotte, N.C.

Doctors “need to be interpreters and balancers of scientific information to help guide patients through the maze of medical hyperbole,” Mason said.

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