Mayo Clinic Proceedings: When Patients and Their Families Feel Like Hostages to Health Care

In the latest issue of Mayo Clinic Proceedings, an article shines light on Hostage Bargaining Syndrome (HBS), which refers to patients who behave as if negotiating for their health from a position of fear and confusion.

“Patients are often reluctant to assert their interests in the presence of clinicians, whom they see as experts. The higher the stakes of a health decision, the more entrenched the socially sanctioned roles of patient and clinician can become,” says the piece.

According to the article, HBS may manifest as a patient asking for less treatment than what is desired or needed, or even remaining silent against one’s better judgment.

“When HBS persists and escalates, a patient may succumb to learned helplessness, making his or her authentic involvement in shared decision making almost impossible.”

To subvert HBS and prevent learned helplessness, the piece says clinicians must aim to be sensitive to the power imbalance inherent in the clinician-patient relationship. They should also be active in pursuing shared decision making by helping patients trust that it is safe to communicate their concerns and priorities, ask questions about the available clinical options, and contribute knowledge of self to clinical decisions about their care.

The piece offers a solution to this syndrome:

“Hostage bargaining syndrome is an insidious psychosocial dynamic that can compromise quality of care, but clinicians often have the power to arrest it and reverse it by appreciating, paradoxically, how patients’ perceptions of their power as experts play a central role in the care they provide.” Click here to read the full story.