When face to face with the doctor, patients may not voice many of the concerns that prompted them to make an appointment in the first place. Only 4 out of 35 patients were able to voice all their concerns to their physicians. The most common unvoiced concerns included worries about a possible diagnosis, fears about the side effects of medication, and concern about being given an unwanted prescription. Past studies have suggested that emotional and social concerns are the least likely to be broached during appointments.
Doctors are in a powerful position in the relationship with patients and need to work to share information and decision-making with the patient and to encourage patients to talk. The reason behind the unvoiced concerns is that patients are behaving as they are expected to -- not as they would like. They need to feel that they can voice the concerns about their illness, including their reluctance to take prescribed drugs. The authors of the study note the shrinking amount of time available for communication between doctor and patient.
British Medical Journal May 6 2000;320:1246-1250
The article did have an interesting element in that many of the physicians were actually envious of their colleagues who are alternative practitioners and get longer sessions with their patients. In the UK, doctors spend on average 7 minutes with each patient. To my understanding it is virtually impossible to treat a patient in 7 minutes. I do not know how they do that without seriously compromising the quality of care rendered to the patient.