Not very, according to recently published research.
Goss and her colleagues (2008) wanted to test how much psychiatrists involve patients in therapeutic decisions and to determine whether there were any defining characteristics (on either the patient’s or the psychiatrist’s part) that contributed to patient involvement.
What’s so great about patient involvement? Well, previous research has shown that the more involved a patient is in the decision-making of their treatment, generally the better the outcomes for the patient. They tend to feel better, sooner, than patients who are uninvolved in the process. Patients who are involved also report higher satisfaction rates with treatment.
This is a small study of only 16 Italian psychiatrists, but the researchers examined 80 transcripts from audiotaped first outpatient sessions. These sessions were rated with a standardized coding system that was developed for this kind of research (called OPTION). Objectively and reliably coding sessions of this nature can be difficult and somewhat monotonous work. So researchers check the raters’ coding skills against one another to ensure that they all are in general agreement.
Despite the study’s small size, the researchers had a significant finding — that psychiatrists made minimal attempts to involve patients in their care:
Psychiatrists showed poor patient involvement abilities parallel to previous findings in psychiatry and primary care. They need to be encouraged to share treatment decisions with their patients and to apply patient involvement skills.
There are a few red flags with the study. There may be cultural differences at play here that may not be replicated on other populations of psychiatrists. And certainly one can’t make broad generalizations based upon a sample size of only 16 professionals. Last, the researchers examined only the first session of psychiatrist-patient interactions. The nature of any first session in mental health treatment is almost always focused on information-gathering and may not be representative of a standard session with the psychiatrist.
Seeing as psychiatrists are trained first and foremost as medical doctors, that they would adopt the medical model’s attitude toward patient involvement is perhaps not that surprising. Many physicians still see patient involvement as something that is a major problem with modern medicine, not the solution.
The world is slowly changing, however. If you want to keep up on the latest regarding these kinds of issues — patient empowerment, patient involvement, partnering with their health care provider, and patient networking — I encourage you to subscribe to the e-Patients.net blog, where these topics are blogged about every day.
Goss, C. et al. (2008). Involving patients in decisions during psychiatric consultations. The British Journal of Psychiatry, 193, 416-421.