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reactance
A negative emotional and
cognitive reaction that results from the
restriction of one’s freedom.
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Module 45
Promoting Health and Wellness
493
emotions, they may seek to restore their sense of freedom but in a self-destructive
manner by refusing to accept medical advice and perhaps acting in a way that worsens
their medical condition. For instance, a man who is placed on a strict diet may experi-
ence reactance and tend to eat even more than he did before his diet was restricted
(Fogarty & Young, 2000; Dillard & Shen, 2004; Woller, Buboltz, & Loveland, 2007).
COMMUNICATING EFFECTIVELY
WITH HEALTH-CARE PROVIDERS
I was lying on a gurney, trying to prepare myself for a six-hour breast-reconstruction
surgery. A few months earlier, I’d had a mastectomy for breast cancer. Because I’m
small-boned, my doctor told me I needed to have a muscle sliced from my back and
moved to my chest to create a proper foundation for an implant. I knew the operation
would slow me down—bad news for someone who swims, runs, and chases three
young kids. But as the surgeon diagrammed incision points on my chest with a felt-tip
pen, my husband asked a question: “Is it really necessary to transfer this back muscle?”
(Halpert, 2003, p. 63)
The surgeon’s answer shocked the patient: No, it wasn’t necessary. And if she didn’t
have the procedure, her recovery time would be cut in half. The surgeon had simply
assumed, without asking the patient, that she would prefer the more complicated
procedure because it would be preferable cosmetically. But after a hurried consulta-
tion with her husband, the patient opted for the less invasive procedure.
Lack of communication between medical care providers and patients can be a
major obstacle to good medical care. Such communication failures occur for several
reasons. One is that physicians make assumptions about what patients prefer, or they
push a specifi c treatment that they prefer without consulting patients. Furthermore,
the relatively high prestige of physicians may intimidate patients. Patients may also
be reluctant to volunteer information that might cast them in a bad light, and physi-
cians may have diffi culties encouraging their patients to provide information. In
many cases, physicians dominate an interview with questions of a technical nature,
whereas patients attempt to communicate a personal sense of their illness and the
impact it is having on their lives, as illustrated in Figure 1 (Ihler, 2003; Schillinger et
al., 2004; Wain, Grammer, & Stasinos, 2006).
Furthermore, the view many patients hold that physicians are “all knowing” can
result in serious communication problems. Many patients do not understand their
treatments yet fail to ask their physicians for clear explanations of a prescribed course
of action. About half of all patients are unable to report accurately how long they
are to continue taking a medication prescribed for them, and about a quarter do not
even know the purpose of the drug. In fact, some patients are not even sure as they
are about to be rolled into the operating room, why they are having surgery (Svarstad,
1976; Atkinson, 1997; Halpert, 2003)!
Sometimes patient–physician communication diffi culties occur
because the material that must be communicated is too technical for
patients, who may lack fundamental knowledge about the body and
basic medical practices. In response to this problem, some health-care
providers routinely use baby talking (calling patients “honey” or telling
them to go “night-night”) and assume that patients are unable to
understand even simple information (Whitbourne & Wills, 1993; Mika
et al., 2007).
The amount of physician–patient communication also is related
to the sex of a physician and patient. Overall, female primary care
physicians provide more patient-centered communications than do
male primary care physicians. Furthermore, patients often prefer
same-sex physicians (Roter, Hall, & Aoki, 2002; Kiss, 2004; Schnatz et
al., 2007; Bertakis, 2009; Bertakis, Franks, & Epstein, 2009).
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