When Dorothea Lack was a little girl, she hid under a doctor's desk to avoid
a vaccination. Undaunted, the doctor crawled under the desk and vaccinated her
then and there. Lack said the incident provoked a fear of doctors that followed
her into adulthood. "I didn't feel I could trust them," says Lack, PhD,
now a psychologist who performs research on doctor-patient relations.
It's a rare soul who truly enjoys visiting the doctor. But for a significant
minority of the population, fear and anxiety prevents them from
getting vital care. The problem has grown in importance with medicine's
increasing emphasis on preventive care. Screenings such as mammograms,
colorectal exams, cholesterol checks, and digital
rectal exams can save lives, but only if people are willing to submit to
uncomfortable procedures well before symptoms have emerged.
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Fortunately, there are proven methods for relieving fear of doctors. But
dealing with the problem first requires fessing up to it. Many people may hide
their fear by saying they don't have time for a doctor's visit, says Jennifer
Hay, PhD, a health psychology researcher at Memorial Sloan-Kettering Cancer
Center in New York. "The first step to putting [fear] in its place is
acknowledging that it's there," says Hay, who also counsels cancer
patients. "Some of the most powerful fears are the ones we don't
Fear of a White Coat
Even if setting foot into a doctor's office doesn't feel like walking into a
lion's den, your body may be priming for a threat.
As much as 20 percent of the population suffers from "white coat
syndrome," in which blood pressure surges when
measured in the doctor's office. The syndrome produces a challenge for
physicians seeking an accurate blood pressure reading. But a fear response in a
health care setting is perfectly normal because most people associate hospitals
and clinics with sickness and injury, says Nathan Consedine, PhD, a health
psychology researcher at Long Island University.
"Fear is a response selected in evolution to promote immediate avoidance
of a very salient physical threat," Consedine says. "Doctor's offices
and hospitals are places where bad things happen, so it's not surprising that
people avoid them." A person with white coat syndrome may not feel anxious
even as her body, "at a low level, is ready to run away."
Our health care anxieties have many sources, Consedine says. We fear the
prospect of a painful procedure; we're embarrassed about being naked or being
touched; or we fear being criticized for unhealthy behavior. The most common
fear is of a bad diagnosis, which helps to explain why as many as 40% of women
who receive abnormal mammogram results do not submit to a follow-up test as
recommended by a physician, Consedine says. "People just want to stick
their heads in the sand."
Lack believes the American health care system tends to exacerbate these
anxieties. Doctors are busier and less likely to build long-term relationships
with their patients, and news stories about medical errors abound. The result
is a reduction in trust in doctors and hospitals that can frighten people away
from care. One of Lack's patients who suffered a bone fracture avoided a
hospital because of news about the prevalence of hospital-based infections. As
a result, the bone healed improperly, Lack says.