Study suggests that the fear your doctor is judging you may have merit

Lots of people believe that vitamin C cures colds or that eating sugar directly causes diabetes. They may also believe that you must walk 10,000 steps a day to be healthy.

If you said one of those things to your doctor, it’s possible that you might take at least a small step down in the physician’s personal estimation of you as a patient, according to a new study by researchers at the Stevens Institute of Technology in New Jersey and Pennsylvania’s Lehigh University.

They report in the journal Medical Decision Making that while it’s very important to have honest conversations with your health care provider so that the professional has the information needed to diagnose and treat you or provide guidance and education about how you should take care of yourself, lots of patients believe they may be judged for mistaken beliefs.

They’re not necessarily wrong.

In a news release on the study, the researchers said that “doctors really do take strongly negative views of patients who disclose incorrect or unreasonable beliefs.” And there are degrees of that. For instance, patients who indicate a strong belief in a medical conspiracy theory — their example is “Medications intentionally cause diabetes as a side effect so people will have to buy insulin to treat it”— or something that’s been widely debunked are held in lower esteem than if they simply got a few details wrong.

“People worry about their doctors looking down on them — and it turns out that’s an entirely rational concern,” said Dr. Samatha Kleinberg, the lead researcher, quoted in the release. “Our study suggests that doctors really do judge patients harshly if they share information or beliefs that they disagree with.”

She added, “We found that our subjects viewed people negatively if they held mistaken beliefs — but viewed them much more negatively if they held more unreasonable or conspiratorial beliefs.”

Why doctors need to get over it

For the study, the researchers surveyed more than 350 patients and more than 200 physicians on their reactions to people who held a range of medical beliefs. Those included both true information and information that’s false across a range. “Some were reasonable (like believing that eating sugar causes diabetes); some were unreasonable (like believing that carrot juice cures diabetes); and some were conspiracy theories (like believing that pharmaceutical companies deliberately cause diabetes to create more customers for insulin),” the researchers wrote in their background material.

Holding negative views about patients because of bad information is probably something doctors need to pay attention to so that they can provide effective treatment to those patients, said Dr. Onur Asan, also of the institute. He said the researchers were surprised at “the degree to which health care professionals held negative perceptions towards patients espousing misinformation.”

You know who else holds a negative view toward patients with mistaken beliefs or information? Laypeople or patients who have personal experience. Those with chronic health conditions, who have learned a lot about health care, “were highly intolerant,” too, surprising the researchers, who figured that they might be more sympathetic.

Kleinberg described the findings as “depressing” and “surprising.” She said, “Laypeople aren’t expected to have medical expertise, so doctors often have to correct mistaken beliefs on health issues. That shouldn’t be something that leads doctors to view patients more negatively.”

It is precisely because most people have some mistaken health beliefs that they need to be able to express them if they are going to be corrected, according to the study. Doctors are supposed to correct wrong information, but it won’t happen if patients are afraid of being judged.

The researchers said that “part of the problem is that it isn’t usually possible for laypeople to know whether their own beliefs are correct or incorrect, or whether they will be perceived as reasonable or unreasonable. That means patients are likely to withhold even true and reasonable beliefs in order to minimize the risk of being viewed negatively by their doctor.”

What is clear, according to the researchers, is that doctors need to make their patients feel safe and comfortable during routine interactions, even if a patient has been misinformed. “Doctors need to overcome their tendency to judge patients, and actively encourage patients to share their thoughts — even their incorrect ones — much more freely than they do,” said Kleinberg.

Other biases

Medical knowledge is not the only realm in which patients can be judged. In 2016, Medscape’s annual survey of doctors found that more than 40% of doctors said they had biases toward some types of patients. The numbers went up in some specialties, including emergency medicine, orthopedics, psychiatrists, family medicine doctors and OB/GYNs, according to CNN .

There were far fewer biases expressed by radiologists, cardiologists and pathologists.

Doctors said they stereotyped patients based on emotional problems (62%) and weight (56% of male physicians and 48% of female physicians). Not enumerated, but also a source of bias were patients’ intelligence, language differences, insurance coverage, age, income, race and attractiveness, per CNN.

Just 15%, however, said their biases impacted their treatment of the patients.

Patients know they might be judged. A 2018 study from University of Utah Health reported by News-Medical found that as many as 80% of patients don’t tell their health care providers the truth — or at least the full truth — about lifestyle factors like diet and exercise. Most said they fear being judged or lectured.

They also tend to stay quiet when they disagree with the doctor’s recommendations or don’t understand them, according to the study, which was published in JAMA Network Open.

Judgment goes both ways

Judgment, by the way, runs in two directions. According to a decade-old article in the AMA Journal of Ethics , doctors feel like they are expected to be perfect and are thus judged for decisions they make, even on their own time. Among other things, physicians seen having a social drink might be judged. Or a physician who is overweight might be judged.

Writes attorney Nadia N. Sawicki, “If the reason society values medical professionals is that they possess valuable clinical skills and exercise those skills with a fiduciary ethic of care towards their patients, we ought to be evaluating physicians on those grounds directly, rather than looking to their behavior ‘after hours.’ It is simply inefficient to look at a physician’s propensity to get into bar fights as an indicator of how well he or she will perform in a professional role. Of course, individual patients are free to set their own expectations for physician behavior — when choosing a primary care physician, for example, I might seek out a physician who regularly attends religious services. Such preferences, however, are personal in nature, and ought not factor into societal, professional or legal expectations of physician behavior.”