If you’re a doctor, chances are your patients are thinking or doing things you don’t agree with. Almost half of Americans believe at least one health-related conspiracy theory, people lie routinely to their doctors about how much they drink, and a lot of act on health information they find on social media without first consulting their doctor. In reality, most adults report hiding information from their doctors.
While some say the responsibility lies with the patients to be more open, this allays patients’ concerns about what might happen if they share their opinions or behavior. Patients may not volunteer to change the dosage of their medications, or actually exercise every day, for fear that their doctor will lecture or get a negative impression of them.
In a recently published study I came to the conclusion that patients are right to be concerned: Doctors Doing judge patients negatively based on the accuracy of what they say.
My colleagues and I surveyed more than 200 primary care physicians and asked them hypothetical questions about patients who shared beliefs that were varying degrees of correct. We found that doctors viewed patients more negatively the more incorrect their beliefs were. A hypothetical patient who shared that “CBD oil lowers blood sugar” was viewed negatively, but less so than a patient who shared that “drinking carrot juice will cure diabetes.” The effect was stronger when patients shared false information that was more relevant to their disease – the very information that has the most impact on a patient’s care. Although we examined judgments based on beliefs – not behavior – we might expect similar results when patients engage in behavior that their doctors do not approve of, such as drinking or drug use.
Rather than just encouraging patients to be more forthcoming with their doctors, which my staff and I believe can come at a cost, doctors need to change their mindset and focus on empathy and education. This way, patients can share freely without being punished for it.
It’s hard to resist the urge to judge, but empathy can counteract this. Empathy is also a skill that can be learnedas educational interventions with physicians have shown. Improving empathy requires connecting with patients as individuals with different backgrounds, needs, and beliefs. Practice perspective taking – imagining what it would be like to be a patient and seeing things from their point of view – can increase both empathy and patient satisfaction.
Doctors may rightly be concerned about more emotional work, while many are already struggling with burnout. But when interns took a course designed to improve empathy, they did fewer emotional exhaustion (part of burnout), while their empathy increased. Many others studies show similar results: rather than contributing to burnout, empathy can be part of its healing. A more empathetic patient encounter doesn’t have to be longer – acknowledging a patient’s feelings, or packaging information in short messages of emotional connection.the heart, head, heart technique), takes seconds. Empathy can also improve healthcare. Studies show that patients are more likely to trust and follow recommendations from doctors they experience as empathetic.
By empowering patients to share their beliefs freely and without judgment, they can experience self-diagnosis by Dr. Avoid Google. While the vast majority of patients perform online searches about their symptoms before seeing a doctor, this can also lead to not receiving necessary medical care and encountering misinformation, such as videos with millions of views that falsely state that potatoes in your socks can cure a cold. When patients are judged on their knowledge, they may rightly view their doctor’s appointment as an exam they need to study for. Some of this information may be useful, but at the same time patients are trying to become better informed and are at risk of becoming less informed.
Physicians must remember that patients are seeking their professional opinions and should not hold patients to a professional standard of knowledge. Patients sharing what they think provides them with an opportunity to educate them, including how to find reliable sources of health information. Furthermore, although patients are not medical experts, they often bring with them an important insight into their own health. Patient reports have provided some of the first evidence of serious side effects from new drugs, such as the discovery that the drug combination fen-phen causes heart damage.
Chatbots or surveys that patients complete at home or in a waiting room can allow patients to reveal important information without having to say it out loud. Yet people prefer to tell a doctor – no chatbot – even potentially embarrassing information. Ultimately, information is shared with the same physician and there is no reason to believe that physicians will be less judgmental about the information provided on a form. Regardless of how patients provide information, physicians should strive not to judge them for it and not allow their responses to influence the way they interact with patients.
The doctor-patient relationship is asymmetrical from the start, especially when a fully clothed doctor walks into a room where a patient is vulnerablely exposed in just a gown. Patients’ experiences shape how they interpret what doctors tell them, but it is not enough to tell patients to be helpful. Doctors must recognize that patients are ultimately not experts and that to err is human – even for patients.
Samantha Kleinberg is the Farber Chair Professor of Computer Science at Stevens Institute of Technology and author of “Why: A guide to finding and using causes.”