We have all been told that there’s no shame in asking for help. Yet asking for help is a hard thing to do for many of us. Shame is a funny thing; it is defined by a fear we have of what others think of us, but yet may come from a fear we have in ourselves, in acknowledging things about ourselves, or a fear in what we actually think of ourselves.
In medicine, a certain degree of shame can be seen in many domains. The mere act of going to a doctor and explaining what is wrong, or asking for advice and help, can be difficult due to feelings of embarrassment a patient might feel. These feelings could be due to a variety of reasons, from merely being a conservative or shy person, to feeling uncomfortable talking about issues with another person that are generally regarded as personal and private. One of the biggest barriers to overcome in medicine is this level of shame or embarrassment a patient might feel when coming to a physician and explaining their symptoms, worries, concerns, or needs. It is an understandable fear though; every one of us can imagine difficulty in explaining a personal issue to another person, whether it is a physician or not. Wondering what they think of what you are saying, if they are judging you, or if what you are describing is unusual or worrisome can all be racing through a patient’s head. These feelings could, and oftentimes do, affect how a patient explains their symptoms and in admitting what they are experiencing.
I have read many studies reporting that patients will oftentimes admit to less than what they actually do behavior-wise and feel symptom-wise. This may be out of shame, fear, or any number of other feelings in which one feels as though they need to make themselves appear a certain way. For example, when answering questions for a patient history, one might admit to less drinking and smoking than he or she actually engages in. Unfortunately, some believe that this happens more often than healthcare providers are comfortable with, a disconcerting event as it can alter the course and severity of conditions and treatments. Truthfulness is an important part of medicine, but an even more important part of life itself. Physicians themselves must overcome their own feelings in order to effectively engage in their position as a healer. Physicians must abstain from giving personal advice on treatment plans or which choice a patient should make; an emphasis on the facts is relied upon as the sole method to presenting options and explaining conditions. The statistics may be vague sometimes, but are still considered the absolute criteria to present to a patient anytime choices are present. This is the classic risk-vs.-benefit argument. Does the benefit of a procedure, a treatment, a decision outweigh the risk? It is absolutely indispensable that a physician present options with no biases, no personal opinions or advice, much in the same way it is essential that a physician make no inkling of a judgment, no mistaken facial expression, no hesitancy, no comment that can be misconstrued when a patient is telling private and personal information. A patient should feel at ease in a doctor’s office, should rely in and depend on the fact that they can confide in the physician as one that will help, not judge.
A few months ago, I was able to job shadow a local family physician two days a week to become comfortable in the office setting and in patient interaction, as well as day-to-day events seen in a family practitioner’s office. Throughout the course of the three months I came in, I sat in on exams and procedures for a wide variety of patients, of different ages, cultures, backgrounds, and experiences. Some patients were absolutely comfortable having a medical student sit in on the patient exam and history, and had no issues describing status updates or symptoms with me present. However, every now and then a patient would whisper to the doctor or mention a symptom, so as not to say it in front of me. Whether it was because I am medical student, and not a physician, or whether it was because of any other factor, such as my age or gender, I cannot say, but I do have my hunches. After two or three times, I became adjusted to reading the physician’s behavior and the patient’s signs, and would excuse myself from the room to get a chart or supply when I sensed some unease on the patient’s part, so as to make the interaction between patient and physician as comfortable as possible. I will say, though, that more often than not, the situation occurred with older men either asking to speak to the doctor alone (who happened to be male as well), asking me to leave, or even making a joke about excusing what they were about to say, and how they do not usually feel comfortable speaking about it in front of a ‘young lady’ but that they realize I am a student and am learning as well. In these cases, a mixture of respect, decency, and shame are likely at play in causing some unease between these patients and having a young, female medical student in the room. These were learning experiences for me, and highly valuable as I reflect upon patient interactions and realizing what I should expect and keep in mind down the road when interacting with patients in an office setting as a medical student under a variety of circumstances.
Shame and decency are a part of every field, but play a significant role in healthcare, where a patient history questionnaire may end up knowing more about you than your best friend, sibling, parent, or significant other. It is undoubtedly difficult to admit your behaviors and experiences to a person you don’t know simply because they are in a uniform signifying their position in the healthcare system. However, this honesty and shamelessness may just be the key to the open patient-physician relationship that leads to the most trusting and effective treatment once can receive.
As the old rhyming adage goes that you’ve been told all your life, honesty is the best policy.