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    Scared to Question Your Doctor? You Could Be Experiencing ‘Hostage Bargaining Syndrome’


    “Hostage” may seem like a harsh word in the context of health care, but a recent study found that sometimes patients with serious illnesses do feel as powerless as hostages.

    Imagine this scenario: You’re in an oncology exam room. This is not your first rodeo. You’ve already been through a couple lines of treatment. The doctors have ordered more tests, and you get the feeling that they suspect that your cancer is spreading. The medical oncologist walks in, and you can tell from the look on her face that the news isn’t good. She begins talking about treatment options.You want to tell her about this side effect you’re been having, but you don’t want to interrupt. You have doubts about one of the options the doctor has described, but you don’t want insult the oncologist or make her feel that you don’t trust her expertise. The doctor must know best.

    Doesn’t sound that far out does it? In fact, numerous studies—here, here and here—show that patients hold back in their conversations with doctors.

    But researchers suggest that, in this situation, the patient is acting like a hostage: He’s negotiating from a place of fear and confusion. He feels dependent on the doctor. He doesn’t want to raise any doubts or concerns. He’s afraid that questioning the medical team will adversely affect his care.

    Scholars call this “hostage bargaining syndrome” (HBS).

    This may not seem like the biggest problem facing a cancer patient. But feeling helpless and not sharing in health decisions can lead to depression and passivity. It may make it difficult for the person receiving treatment to adhere to treatment protocols and medication schedules. Worst of all, this dynamic make the doctor feel that the patient doesn’t care. Reactions can be missed, early warnings of trouble might not come to light.

    The authors of this recent paper make a point worth considering: Medical care goes better when the patient and the medical team work together, share concerns, questions and information.

    In the medical field, this is known as “shared decision making.” I was lucky enough to have cancer treatment at a medical center that had a whole department, “Decision Services,” dedicated to encouraging doctor-patient teamwork.

    Ask your medical team questions. Make sure to think about what outcomes matter most to you. Think of concrete goals and priorities. How can you increase the odds of those outcomes given your clinical situation? What are the risks and benefits of the various treatment options before you? If you don’t feel up to asking these questions, have a friend or family member do it. You’ll get better care if you do.


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