When we land in hospital for an extended time, most of us put our faith and safety in the hands of the medical staff. It takes a brave person – or an advocate – to buck the system and not take things lying down (pun intended).
I was brought up in a small country town and the local police officer, bank manager and principal were revered figures. If there had been a doctor, she or he would also have been in that category – which leaves me, and many others, less likely to question authority figures.
It might also make us susceptible to HBS. Have you heard about this condition?
HBS is Hostage Bargaining Syndrome, a phenomenon where patients behave as if negotiating for their health from a position of fear and confusion.
Research that identified HBS was conducted by Monash Business School and the Texas A&M University.
Professor Tracey Danaher, from Monash’s marketing department, says researchers looking through sociology studies on hostages had observed 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,” she 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 judgement.”
Longer-stay hospital patients can be made to feel like exhibits who are talked about instead of with. And despite the best of intentions, time-poor medical staff are likely to shun a more collaborative approach to discussions about treatment and progress.
A shared decision-making approach, where doctors present options and patients explain their preferences, allows the medical team and the patient to share concerns, questions and information, Professor Danaher says.
The Monash-Texas University study found that the higher the stakes in a health decision, “the more entrenched the socially sanctioned roles of patient and doctor can become”.
It identified cancer and intensive care patients, and their families, as particularly likely to feel powerless in relation to their care.
The problem could be worse if medical errors or unexpected side-effects occurred.
“But this can be lessened if doctors share the responsibility for making decisions with the patients and their families,” the study says.
Professor Danaher explains that shared decision-making is more likely to lead to less invasive, less intensive treatments.
“For example, consumers advise hair stylists of their preferences and may give real-time feedback during the service. Patients should feel as comfortable doing this in medical care as they do in hair care, but this is not always the case.
“To do so, patients need to feel a true sense of partnership, where both parties feel safe in communicating with each other in a context of mutual trust.”
To subvert HBS, doctors must aim to be sensitive to the power imbalance, the study say.
They should then pursue shared decision-making and make patients feel comfortable about communicating their concerns and priorities.
Do you identify with Hostage Bargaining Syndrome?