Why People Don’t Tell Their Doctor About Life-Threatening Issues
August 28, 2019
- A new study found that nearly half of people who live with depression, have faced domestic violence, have thoughts of suicide, or are survivors of sexual assault, are more likely to keep this information from their doctor.
- Seventy percent of those surveyed said embarrassment and the fear of being judged motivated them to avoid disclosure to their doctor.
- The desire to not want to engage in a difficult follow-up as well as not wanting this information to be preserved on their medical record were cited as top reasons why patients withheld information.
- Keeping doctors in the dark can have a negative impact on a person’s health by keeping them from receiving the most comprehensive care or a potentially life-saving treatment.
New research shows that a high number of people who are dealing with some serious, sensitive health issues find it too difficult to disclose this information to their doctors.
This can have major implications for their overall health.
The new study published in JAMA Network Open shows that people who report they live with depression, are survivors of sexual assault, have faced domestic violence, or have thoughts of suicide, specifically, are more likely to keep this information private from their health providers.
The researchers analyzed responses from more than 4,500 people from two online 2015 national surveys. They varied in age — one survey’s average respondent age was 36, the other had a median age of 61 — and were asked if they ever withheld information from a doctor on these various health threats.
They found that up to 47.5 percent of these people opted out of telling their doctors about at least one of the health issues.
Why did so many keep this crucial information private?
The study revealed that over 70 percent of these people said embarrassment and fear of being judged motivated them to avoid disclosure to their doctor.
And the odds of this information being kept private were higher for female respondents as well as those who were younger.
Angela Fagerlin, PhD, the study’s senior author, told Healthline she was struck by these high rates and was distressed to see the high number of people who kept important information close to the chest out of fear of embarrassment or judgment.
Dr. Fagerlin, who is the chair of population health sciences at University of Utah School of Medicine, said that fear of embarrassment ranked as the top reason, followed by concern over being judged or lectured.
In addition to these reasons was the desire to not engage in a difficult follow-up as well as not wanting this information to be preserved on their medical record.
Scott Bea, PsyD, of the department of psychiatry and psychology at Cleveland Clinic, explained that many patients can have qualms about being honest about troubling health concerns when they walk into the doctor’s office.
“Some of the reasons that individuals may withhold information include not feeling a strong alliance with their health professional, uncertainty about how the information will be handled by the professional, fearing potential consequences of revealing information of this nature, and cultural stigmas regarding behavioral health concerns and victimization,” said Dr. Bea, who wasn’t affiliated with this research.
Hiding this information from your doctor can have something of a domino effect on your health.
Depending on what you’re visiting your doctor for, you might not receive the most comprehensive, necessary treatment if your provider doesn’t have access to crucial information on your overall health.
Fagerlin said that, for example, a person who doesn’t disclose a recent sexual assault may not be getting screened or treated for sexually transmitted infections.
Similarly, staying mum about some of these topics means you might not receive crucial medical treatment for depression that could be hiding under the radar.
Issues like sexual assault, domestic violence, suicide, and depression are incredibly complex. Just as there’s no one-size-fits-all approach to treatment for everyone, there’s no universal standard for best practices to disclose this information.
For example, a 2011 studyTrusted Source looked at the characteristics of sexual assault disclosure for both Caucasian and African American survivors. Overall, those surveyed reported they were positively supported by those they shared their information with.
But if you look closer, it gets more complicated.
White survivors were much more likely to disclose at all compared to their black counterparts. What happens during the disclosure also varied by race.
African American survivors who chose to disclose their assault to a professional provider “received significantly more disregard than did Caucasian survivors,” the study authors wrote.
These results somewhat echo the motivations of the respondents in the new study.
Sometimes, particularly vulnerable populations don’t always have reason to trust they’ll be well received by their doctors when they come forward with serious, heavily personal information.
Bea said that communication skills are increasingly becoming part of the training in medical schools “with the understanding that the alliance that is formed with a patient is one of the best predictors of a positive outcome.”
“Teaching physicians how to make these sensitive inquiries in a caring and non-perfunctory manner is very important,” he added. “At the same time the current climate of healthcare that pushes physicians to see high volumes of patients can be a deterrent to having physicians utilize these empathic skills that produce solid alliances and accurate self-disclosure.”
When it comes to the male-female disparity revealed by the new study, Fagerlin said she and her team didn’t investigate why female patients are more likely to stay private about these topics than male patients.
“One consideration is that women interact more with the health system than men and may have more opportunity to interact with providers,” she explained. “It’s an issue we would like to understand better and it’s critical that we better understand how trust and communication differs for women.”
While not examined by this new study, it’s possible that groups often stigmatized by society at large — such the LGBTQ community, ethnic and religious minorities, and people who have at-times misunderstood conditions like HIV — might similarly be leery of divulging sensitive information to doctors.
From the psychological perspective, Bea said people are “judging by their nature.” While judgments are “often formed as a safety behavior, [they can be] applied in ways that are hurtful to individuals and groups with shared struggles.”
“Developing cultural norms of acceptance, including the acceptance of ordinary displays of humanness, can facilitate more active and accurate self-disclosures by patients,” he said.
“Additionally, training and testing a physician’s capacity to create an atmosphere of safety, genuine concern, and acceptance is another step to reducing the inhibition toward disclosing information on the basis of shame or embarrassment,” Bea continued.
This new research poses a big question: Is there a greater erosion of trust in doctors — especially among members of vulnerable populations — happening today?
Fagerlin stressed her study’s data can’t show if this is the case. She explained, “it may be a trust issue, but there are many other potential explanations [as well].”
“For example, societal norms may be leading people to be embarrassed by their vulnerabilities, thereby making people less willing to disclose them to anyone — including their providers,” she said.
An essay published in The New England Journal of Medicine cites that out of the rest of the industrialized world, Americans have a particularly low level of trust in medical institutions.
This also fits in with a lessening trust in institutions as a whole throughout the nation.
While people should always go to their doctor with a serious medical concern, if a person feels they need to look for another option, there are alternatives where they can get counsel or medical help.
Bea suggested people look to “a trusted friend, partner, or confidant [when] self-disclosure to a physician may be challenging.”
“Additionally, they may seek out a behavioral health professional to help them explore ways in which they might be able to offer these communications with less shame, guilt, or fear of negative consequences,” he said.