Intimidated patients ‘bargain like hostages’


Patients who feel unable to assert themselves in the presence of health professionals negotiate as if they are being held hostage, says new research

Some patients fear speaking up and display traits similar to hostages in what appears to be the result of an imbalance of power between the patient and medical staff, says Professor Tracey Danaher from the Department of Marketing at Monash Business School.

The research, from Monash Business School and the Texas A&M University, shows that “hostage bargaining syndrome” (HBS) can be reduced if doctors share the responsibility for making decisions with the patients and their families.

Prof Danahder says HBS is “a very real phenomenon” experienced particularly by those with a serious disease or in a state of great vulnerability.

She says that when the researchers were looking through sociology research about hostages, they saw a reluctance to challenge authority.

“We thought – this is similar to patients who are often very reluctant to assert their interests in the presence of doctors, who they see as experts,” Prof Danaher says.

“It may manifest as understating a concern, asking for less than what is desired or needed, or even remaining silent against one’s better judgment.”

The research showed that patients fear speaking up as they do not want to offend doctors, and this may vary depending on one’s educational, demographic or social class.

Even educated and affluent people who are used to being in control often find themselves without their customary authority, voice, and independence when serious illness strikes, the researchers found.

One patient told of overhearing a nurse label her as “difficult” when she refused an attempted blood sample draw until they controlled the pain.

“I sat wordlessly as the surgical team attributed my pain to an imagined tolerance to opioids,” this patient told researchers.

“I felt powerless. I pathetically tried to ingratiate myself to the care team as I believed that I needed to make them like me in order to receive their best care.”

The research shows that the behaviour of adult kidnapped hostages has been categorised into three areas:

  • cognitive (confusion and disorientation);
  • emotional (fear and anxiety); and
  • social (withdrawal and avoidance).

This correlates directly with the experience of some patients, the researchers say.

While doctors who experience this behaviour in patients do not want their patients to feel like hostages and encourage patients’ involvement in shared decision making, reducing HBS can be challenging, especially in time-poor medical settings and in the context of competing priorities, the researchers say.

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