Taking Aim Together

A new study underscores the need for consumers and psychiatrists to talk about what they want from treatment. Schizophrenia Digest takes a look at this important issue and investigates ways in which consumers and psychiatrists are working together.

By Chris Martell
Schizophrenia Digest

The relationship between a physician and patient is, inevitably, as fragile and complicated as a cobweb.

When problems in the body arise there is, in one corner, a doctor in a starched lab coat, bolstered by academic credentials and the medical community. In the other corner is the patient, naked beneath a paper gown, feeling vulnerable as he or she is poked, prodded and examined.

When illness involves the brain, the dynamics between physician and patient become even more complex. A person’s most private thoughts, beliefs and life goals are being scrutinized, and ultimately judged, by a psychiatrist. With a prescription pad, the doctor can try to rewrite the script in their patient’s mind and—while they’re at it—bring on a cornucopia of side effects that may change the patient’s life just as profoundly.

The lack of balance in the doctor-patient relationship is particularly acute in schizophrenia, often characterized by a consumer’s lack of insight into his or her condition.

For a decade, there has been growing dialogue in the psychiatric community about the role of doctors in the treatment of schizophrenia, much of it led by Dr. Ronald Diamond, a psychiatrist at the University of Wisconsin-Madison, who also works with patients living in the community.

“We are still not doing a very good job of listening to patients,” Dr. Diamond has said, echoing a warning he’s been sounding for years. “The treatment of schizophrenia could be greatly improved if physicians better understood the goals of their patients.”

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The fundamental question is this: Are doctors inflicting their own goals on their patients, or are they helping their patients lead the kind of lives they really want?

That question was addressed in a recently published study, commissioned by Janssen Pharmaceutica Products and co-authored by Dr. Diamond, in which psychiatrists and people with schizophrenia were asked to rank their treatment goals.

The 199 consumers surveyed and the 291 doctors who participated have many of the same broad goals: improved overall happiness and mental health are at the top of the list of shared goals.

Other similar rankings between patients and doctors included improved ability to express oneself to others, reduced depressive thoughts, improved family relationships, less agitation and irritability, fewer suspicious thoughts about others, less dependency on others, fewer sexual side effects and less frequent visits to the psychiatrist or counselor.

But the study also highlighted some differences between the goals of physicians and patients. Doctors valued minimizing the side effects of medication more highly than the patients did. And patients cared more about social activities than the doctors did.

The survey revealed that physicians have higher treatment goals than their patients. It suggests that patients may not have high hopes for the success of their treatment, and are not freely discussing their own unmet treatment goals with their doctors. Because of the survey’s findings, physicians are urged to discuss treatment goals and progress toward these goals with individual patients in order to increase their satisfaction.

“In the past, we assumed that patients agreed with our ideas of reasonable treatment,” Dr. Diamond said. “But more and more, I think we are starting to listen to what our patients want in a different way.”

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Chris Martell is a feature reporter for the Wisconsin State Journal in Madison, Wis.

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