Acknowledging and mitigating power disparities in physician–patient/proxy negotiations

Abstract

Background

This article offers advice to physicians on how to improve their negotiations with patients and patients’ proxies by addressing with the inherent power disparities between the two parties.

Methods

No study was performed. This article draws from negotiation and conflict resolution literature and applies those theories to physician practice.

Results

No study was performed. However, the central premise follows from the conclusion of previous studies that highlight: Greater power disparity between negotiators leads to more hostile negotiation tactics, whereas increasing and balancing power lead to more amicable and conciliatory behavior.

Conclusions

Based on the abovementioned thesis, I offer recommendations to physicians on how to manage power using three different approaches: (1) empowering the patient or proxy; (2) managing one's own power appropriately; and (3) providing better processes. All three recommendations are meant to foster more productive negotiations for all parties involved.

Keywords:

• Negotiation
• Patient
• Physician
• Patient−Physician
• Power
• Disparity

Additional information

Notes on contributors

Mathew David Pauley

Mathew David Pauley joined Kaiser Permanente's Southern California team of clinical ethicists in September 2010 as the Medical Bioethics Director for Fontana and Ontario Vineyard Medical Centers. Prior to joining Kaiser Permanente, Mathew was the postdoctoral fellow with Northwestern University Feinberg School of Medicine's Medical Humanities & Bioethics Program, where he penned this article and lectured on the intersection of conflict resolution, medical education, and bioethics.