Do patients prefer optimisitic or cautious psychiatrists? An experimental study with new and long-term patients.

Abstract

BACKGROUND: Patients seeking treatment may be assumed to prefer a psychiatrist who suggests a new treatment with confidence and optimism. Yet, this might not apply uniformly to all patients. In this study, we tested the hypothesis that new patients prefer psychiatrists who present treatments optimistically, whilst patients with longer-term experience of mental health care may rather prefer more cautious psychiatrists. METHODS: In an experimental study, we produced video-clips of four psychiatrists, each suggesting a pharmacological and a psychological treatment once with optimism and once with caution. 100 'new' patients with less than 3 months experience of mental health care and 100 'long-term' patients with more than one year of experience were shown a random selection of one video-clip from each psychiatrist, always including an optimistic and a cautious suggestion of each treatment. Patients rated their preferences for psychiatrists on Likert type scales. Differences in subgroups with different age (18-40 vs. 41-65 years), gender, school leaving age (≤16 vs. >16 years), and diagnosis (ICD 10 F2 vs. others) were explored. RESULTS: New patients preferred more optimistic treatment suggestions, whilst there was no preference among long-term patients. The interaction effect between preference for treatment presentations and experience of patients was significant (interaction p-value = 0.003). Findings in subgroups were similar. CONCLUSION: In line with the hypothesis, psychiatrists should suggest treatments with optimism to patients with little experience of mental health care. However, this rule does not apply to longer-term patients, who may have experienced treatment failures in the past. KEYWORDS: Communication; Information; Pharmacotherapy; Psychiatric treatment; Psychological treatment; Treatment expectations