Related Experiment Video
Updated: Dec 24, 2025
Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
What to do when patients and physicians disagree? Qualitative research among physicians with different working
Rozemarijn Lidewij van Bruchem-Visser1, Inez Duconia de Beaufort2, Francesco Umberto Salvatore Mattace-Raso3
1Department of Internal Medicine, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands. r.l.visser@erasmusmc.nl.
Purpose:
Impasses between patients, relatives and physicians occur frequently. With the growing attention for shared decision making, it is valuable to know how impasses arise. To understand the challenges experienced by physicians when their opinion on medical decisions differ from those of patients or relatives.
Methods:
Fifteen physicians with different working experiences, from five medical specialties were interviewed using a narrative approach. Interviews were based on two patient stories provided by the physician. First of a patient (or relative) who did not want to adhere to a treatment the physician deemed necessary, and the second of a patient (or relative) who requested a treatment the physician felt was unnecessary. Data were analyzed using a bottom-up approach, with identification of five themes (autonomy of the patient, communication, emotions, circumstances and metaphors). Twenty subthemes were formed.
Results:
693 references were made. Six major nodes were identified: frustration experienced by the physician, role of the relatives, agreement, cultural/religious aspects, comprehension by the patient of the situation and the existence of an established relationship between patient and physician.
Conclusions:
Physicians felt uncomfortable when there was disagreement between themselves and patients or relatives. Frustration was felt when relatives spoke on behalf of the patient, while there was no evidence the desired decision was ever expressed by the patient. A disagreement with a patient was described as being less frustrating, when the patient was able to explain the reasons for making a decision. Differences in background, especially religious, were often mentioned as complicating communication.
Insights
Physician disagreements with patients or relatives often cause frustration, especially when family members speak for patients. Clear patient communication and understanding diverse backgrounds can ease these medical decision-making impasses.
Area of Science:
- Medical Ethics
- Health Communication
- Physician-Patient Relations
Background:
- Medical decision-making frequently involves disagreements between patients, their relatives, and physicians.
- Shared decision-making models highlight the importance of understanding the origins of these impasses.
- Physician perspectives on differing medical opinions are crucial for improving patient care.
Purpose of the Study:
- To explore the challenges physicians face when their medical opinions diverge from those of patients or relatives.
- To understand the factors contributing to impasses in medical decision-making.
Main Methods:
- Qualitative study involving narrative interviews with fifteen physicians across five medical specialties.
- Interviews utilized two patient scenarios: one involving treatment refusal and another involving treatment request.
- Data analysis employed a bottom-up approach, identifying five key themes and twenty subthemes.
Main Results:
- Six major nodes emerged: physician frustration, the role of relatives, agreement, cultural/religious factors, patient comprehension, and the patient-physician relationship.
- Physicians experienced discomfort and frustration, particularly when relatives overstepped patient autonomy.
- Patient's ability to articulate reasons for decisions and established relationships mitigated frustration.
Conclusions:
- Physician discomfort arises from disagreements, especially when relatives speak for patients without clear patient input.
- Cultural and religious differences significantly complicate communication and decision-making.
- Enhanced patient communication and understanding of diverse backgrounds are vital for resolving medical impasses.
More Related Videos
Related Concept Videos
01:27Ethical Issues
Ethical Concerns in Healthcare:
01:08Obedience
01:21Barriers to Effective Communication II
Cultural barriers:
Differences in values, beliefs, religion, knowledge, and tradition can significantly impact communication. Awareness of nonverbal cues is critical, especially when conversing with a patient from a different culture. What appears appropriate in one culture may be inappropriate in another.
Semantic barriers:
As a result of their tendency to use...
01:30Ethical Dilemmas II
01:22Ethics and Bioethics
01:17Ethical Dilemmas I
Let us explore some examples to understand the potentially complex moral decisions nurses face.
Take the case of caring for minors, particularly in areas related to reproductive...