title: Ignorance isn't bliss: why patients become angry.
abstract: Patients with cognitive limitations may struggle understanding complex arguments and feel overwhelmed by the need to choose among medical options that they poorly understand. Such struggle may result in frustration and anger directed at the physician. The aim of the present study is to explain the characteristics underlying such situations. A decision tree is modeled to capture the choice that every patient has to make after receiving medical advice. Patient choices are phrased in terms of a threshold probability for accepting or rejecting advice by physicians. To a patient with poor understanding of medical exigencies all differences between present or absent disease state, prognosis, and risks of intervention may seem largely arbitrary and meaningless. With little or no guidance to make an informed decision, taking any medical action is deemed wasted and harmful, whereas inaction leaves the underlying medical problem unsolved. Both choices appear equally ineffective with respect to the patient's symptoms and therefore unappealing. As shown by applying threshold analysis to a patient in a state of ignorance, no threshold probability for following medical advice exists. Patients with cognitive limitations will become frustrated and angry by a seemingly dismal situation without good alternatives to choose from.
authors.affiliation: The Portland VA Medical Center and the Division of Gastroenterology/Hepatology, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Amnon
authors.initials: A
authors.lastname: Sonnenberg
mesh_terms: D000786:Anger; D002755:Choice Behavior; D032882:Comprehension; D003663:Decision Trees; D005639:Frustration; D005767:Gastrointestinal Diseases / Q000523:psychology* / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010353:Patient Education as Topic; D035501:Uncertainty