Are you happy with your healthcare provider? Most people are happy, even if they’re unhappy with the health care system as a whole. But if you’re unhappy with your doctor or your care, how likely are you to say so or search out a new healthcare provider?
Visiting your doctor can be intimidating; so much so, the term “white coat hypertension” is commonly used to describe the anxiety-driven elevated blood pressure that people experience in the medical office setting. Such an environment doesn’t exactly set the stage for patients to ask questions or express concerns with their healthcare provider’s recommendations.
A recent article in Medical Care by Dr. Steven C. Martino and colleagues discusses how vulnerable populations may be even less inclined to disagree with their provider or change doctors if dissatisfied with their healthcare.
The authors reviewed Medicare data for nearly 100,000 people from the 2014 Medicare Consumer Assessment of Healthcare Providers and Systems survey. The authors wanted to see how particular populations handled dissatisfaction, including those older than 85 years of age, those with a lower education (i.e., without a high school degree or equivalent), those with lower income (<150% of the Federal Poverty Level) and those with minority backgrounds (who were compared to data from non-Hispanic white Medicare beneficiaries).
The authors found that, if dissatisfied, 1 in 5 survey respondents would be “unlikely” or “very unlikely” to tell their doctor they disagree with them. Further, about 1 in 3 respondents would be “unlikely” or “very unlikely” to change doctors if they experienced dissatisfaction with the way they and their doctor communicate. Older people and those with less education were less likely to do either, while those with lower income would only be less likely to change doctors.
The results by race and ethnicity were more complicated to interpret. Hispanic and Asian/Pacific Islander Medicare beneficiaries were less likely to express disagreement, whereas black beneficiaries were more likely to disagree when compared to white beneficiaries. American Indian/Alaska Native beneficiaries were similar to white beneficiaries when expressing disagreement. In regard to changing doctors, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native were less likely to change doctors; however, black beneficiaries were were similarly matched to white beneficiaries.
The authors stress how not feeling empowered to express disagreement or address ongoing dissatisfaction by easily changing doctors can be a contributor to healthcare disparities. Patients need to be encouraged to speak up, and feel free to express their opinions, perspectives, and concerns about their healthcare. Patients also need the ability to change doctors, which can be disruptive if you have complex health problems that require continuity of care, or near impossible if there is a shortage of providers from which to choose.
Health care providers can help by building trust and supporting open communication. Trust is a key component for patient satisfaction, especially among vulnerable populations. Further, improved trust can also have downstream benefits such as medication compliance.
The steps to enhance trust can take many forms, and are not necessarily one-size fits all. Emotional needs may differ from patient to patient based on their diagnosis, background and personality. But previous qualitative work in patients with HIV gives us one example of specific actions providers can take to help reduce their patients’ anxiety and build trust early in the relationship:
- Provide reassurance
- Reinforce it’s okay to ask questions
- Show patients their test results and explain them
- Avoid judgmental language and behaviors
- Ask patients about what they want
Patients have a role in building this trust as well. They need to feel empowered. The next time you see your health care provider, reflect on the interaction and consider what methods you use to advocate for yourself or family and communicate preferences with your provider. What helps you to feel heard? How easy is it for you to question your provider’s recommendations? These are important questions to consider when identifying methods to help vulnerable populations effectively engage in their care.
Alexa Ortiz
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