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Anxiety and the Doctor-Patient Relationship: Theory and Some
Evidence
Botond K}oszegi, UC Berkeley
September 2003
Abstract
This paper identies an array of complications in doctor-patient communication that arise
when the patient suers from anxiety. I assume that the patient derives utility from health
outcomes as well as the anticipation of the exact same outcomes, and that the doctor wishes
to maximize the patient's utility. The doctor privately (and probabilistically) observes a diagnosis,
which aects the optimal treatment. She then sends a message to the patient, who
chooses a treatment. If the doctor cannot certiably communicate the diagnosis, communication
is endogenously limited to a treatment recommendation, which the doctor distorts toward
the treatment that is optimal when the patient is relatively healthy. Paradoxically, more emotional patients get worse recommendations, even though basing their treatment choice on better recommendations would make them less anxious. If the doctor can certiably communicate the diagnosis, she does so for good news, but unless she needs to \shock" the patient into behaving correctly, she pretends not to know what is going on when the news is bad. If the patient visits two doctors in a row, the second doctor reveals more information than the rst one, and the rst one gives more information to patients who do not want to know what will happen to them than to those who do want to know. Results from an original survey of practicing physicians conrm that doctors care about patients' emotions, and alter their recommendations and other communication in response to them.