New Survey Reveals Most Patients Uncomfortable Confronting Medical Personnel

Provo, Utah, March 7, 2005 – Medical mistakes are the bane of millions of well-intended health care professionals who are working to fool-proof their systems and practices. In support of National Patient Safety Awareness Week (March 6-12, 2005), VitalSmarts has released results from a new study that suggest patients often play an unwitting role in bringing about these mistakes by not confronting their healthcare practitioners.

The study identified patients who had recently encountered problems from feeling mistreated by healthcare practitioners, to feeling worried their care provider was making a significant mistake. It found patients usually say nothing about their concerns – and their silence puts them at risk for significant personal harm.

“Patients often find themselves in a quandary, worrying their health care professional is acting on poor information,” says Joseph Grenny, author of the study and president of VitalSmarts. “The patient feels they have to choose between being respectful and sharing their concerns. Given these two choices, they don’t speak up.”

The survey found:

  • Less than half of patients spoke up when the caregiver was unclear about the diagnosis, treatment options or next steps.
  • One in five of these people have suffered “substantial” health problems as a result of not speaking up.
  • When patients believed the care provider was making a medication error, they were more inclined to speak up – yet more than a third did not.

“The key is to be candid without being offensive,” says Grenny. “People worry about speaking up because they don’t want to cause offense. We’ve spent more than 10,000 hours watching people who know how to respectfully handle these crucial conversations.”

Grenny says there are some simple communication skills patients can learn to step up to crucial conversations with their care providers and avoid preventable errors:

  • You are the expert. Realize you have important information about your past experiences, your current symptoms, etc. that your medical professional desperately needs to make informed decisions. You are the expert and should not defer by assuming the caregiver knows everything.
  • Speak up early. Often we wait to speak up until we are so angry we end up offending our caregiver. Speaking up sooner when you are less upset, worried or angry will inevitably yield better results. If you are already angry or upset, remind yourself this is probably a harried professional who is doing their best under the circumstances. Then open your mouth in a way that helps them rather than insults them.
  • Show respect. Your doctor or nurse feels “unsafe” when they believe you don’t respect them. This feeling causes them to become defensive with you. Before describing your concerns, start by affirming your respect for their competence and position. For example: “I’m grateful for your attention to me and want you to know that I value your experience and skill in treating me.”
  • Share the facts. Caregivers have a hard time with vague statements like, “Are you sure that’s right?” or accusations like, “I don’t like the way you’re talking to me!” Stop and think about what is happening that is making you uncomfortable. Look for the concrete facts that will help the caregiver understand clearly what is bothering you. For example, “The last time I took this medication I was given a white tablet to take twice a day. This time it says four times a day and is a yellow tablet.”
  • End with a question. Show once again you are interested in the professional’s point of view by ending with a question. “Is this correct?” or “Why should I not be worried here?”

Grenny’s tips are based on his New York Times bestselling book, Crucial Confrontations: Tools for Resolving Broken Promises, Violated Expectations, and Bad Behavior (McGraw- Hill, 2004, $16.95). Visit for free resources and to join our new online forum – ask communication experts how to handle your tough situations.

Survey results come from a poll administered to 20,000 website subscribers.


About VitalSmarts

Leaders in organizational performance and leadership, the founders of VitalSmarts have coauthored three books including two New York Times bestsellers: Crucial Conversations (McGraw-Hill, 2002), and its newest title, Crucial Confrontations (McGraw-Hill, 2004). VitalSmarts has trained more than 300,000 people worldwide including leaders of 300 of the Fortune 500 companies in these and others skills. The company was founded in 1990 and is privately held.

Note to editors: Joseph Grenny and co-authors Ron McMillan, Al Switzler and Kerry Patterson are available for interviews. They can also share real experiences of patients who didn’t speak up, as well as stories of those who did and experienced better care.

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