I recently read an article stating that nearly half of patients who were surveyed online admitted they don’t tell doctors potentially life-threatening details of their history. This figure may even be an under-representation of the facts, as some people may not admit to withholding information, even anonymously and online.
This fact stopped me in my tracks. But it did get me to thinking: why is this the case and what can we, collectively, do to change the situation?
The data came from a study published on line in JAMA where 4510 people responded to on line surveys. Responses indicate that up to 47.5% did not share critical information with their care providers in one or more of four categories that could pose an imminent threat:
- potential for experiencing domestic violence
- survival of sexual assault
- struggles with depression
- suicidal thoughts.
More than 70% of those who withheld information said they did so because of embarrassment. Several other reasons were cited.
Reasons for not divulging this information included:
- being embarrassed 72%
- not wanting to be judged or lectured 66%
- not wanting to engage in difficult follow-up* 62%
- not wanting the information in their medical record 57%
*difficult follow up could be “taking antidepressant medication or seeing a therapist”
Whilst there may well be limitations of this study, it raises serious questions for us all to consider.
Why do our patients feel judged by us and too embarrassed to share important, intimate and potentially life-saving details of their health and their lives?
Can we place all the responsibility of this onto them or would it serve us to look at our part in it? For after all, we are all in relationship with each other, all of the time, including and perhaps especially doctors and patients. Doctors are the most trusted professionals in our society, and this trust needs to be honoured. The nature of our relationships with our patients is particularly delicate because of the potential power imbalance and because of the intimate nature of the details we share and the physical examination and care of the human body and being.
Some may say that doctors just don’t have enough time any more to sit and listen to their patients’ stories, and while that may be true, that the increasing constraints of modern medicine have made it harder for us to spend enough time with our patients, it is also true that people feel everything, including our impatience, our judgement, and in some instances making our need to make money or get the job done more important than our need to truly meet and connect with people. And I think there is more to it … I think it is not just about time; it is about space.
Giving people space is not about keeping a distance between us. Giving people space means understanding that we are all in this together, on this blue-green planet we call Earth, and that we are breathing the same air, sharing the same space, and that we are all, deep down, in essence the same.
We are one species, called human being. It is much harder to judge someone if you know they are your equal inside, no matter what they may look like or how they may behave on the outside.
Try as we may to believe that life is only physical, and that we are merely physical, we are all so much more than that; we are all divine beings, pretending not to be divine, and some people go to great lengths to hide their great light. But it is there, living inside us all, nonetheless.
Once we feel this again, and come to understand that everyone is doing their best, sometimes under very difficult circumstances, it is very hard to judge anyone, and much easier to see more clearly what they are doing and why. And people feel held in this space. They open up, and start to let go of their protection, and learn to trust again. And in that space they can reveal their secrets, their shame, their guilt and fears. And if we can hold them in that space, accepting them just as they are, no matter what they have done or not done, they feel met, and truly loved.
This is a great untapped source of healing that most of us dismiss or do not make use of as health care practitioners. Perhaps as great as any pill we may prescribe, any test we may order and any surgery we may perform, is the power of meeting people as a fellow and equal human being, and accepting them as they are.
True medicine is restoring this healing power of human connection and true intimacy to the already great work we do. And this is healing for us too. It is not so easy to get bored, burnt out or depressed if we work with people and we love being with people, for our interactions are always enriching life.
Let’s make medicine about people again, first and foremost, and without judging ourselves or each other, open up to the intimacy, and the space, that is always on offer.
A relatively new policy in the US is asking the patient, on medical forms and directly, if they have been or are in unsafe situations. It is a welcome addition to a patient’s history however the question remains as to whether or not victims feel safe sharing the information with a doctor they may or may not have a solid, trusting relationship with. Many doctors are dealing with time management constraints imposed by office managers and victims are coming from a life of secrecy and fear. It would be interesting to know if this new approach to addressing abuse is effective for patients and doctors.
That is really interesting to know, Kim, and thank you for sharing. I also have my patients fill in a questionnaire before I see them and although I don’t ask that specific question, I notice that giving them the space to reflect on their history does bring more out than if you just ask them to remember or express on the spur of the moment…