When Your Doctor Shames You

New research has found that while 50 percent of patients leave their doctor’s office feeling ashamed or guilty, those feelings may have positive results depending on a number of factors.

Researchers from the University of California San Diego said that investigating the issue of patient shame – and consequent avoidance of treatment – is crucial.  "More than one third of all deaths in the United States are still essentially preventable and largely due to unhealthy patient behavior,” the researchers wrote.

The research, published in the journal Basic and Applied Social Psychology, analyzed the experience of 491 UCSD about their feeing of shame when interacting with a physician. Another survey looked at both guilt and shame in the experience of 417 people aged 18 to 75.

Both groups cited weight and sex as the most frequently shaming topics. Other topics included teeth (among younger patients), substance abuse, mental health or not taking prescribed medicines.

The outcomes of the encounters varied from making the lifestyle changes discussed to avoiding doctors altogether.  The results can be traced to whether the patient "makes a global attribution, condemning the entire self" or just condemns the behavior at hand, according to Christine Harris, professor of psychology in the UCSD Division of Social Sciences.

"People who report a more positive reaction focus in on a bad act not a bad self," Harris said. "In the simplest terms: Those who say 'I'm a smoker' or 'I'm a fat person' may feel resigned while those who say 'I smoke' or 'I eat too much' also seem to think 'I can stop doing that.'"

The patient’s perception of the doctor is also crucial.

"If you perceive your doctor is intentionally trying to make you feel shame or guilt, then the reaction is exclusively negative," Harris said. "We didn't see any positive reactions at all."

The researchers found gender differences as well:  Women were likelier to report shame and guilty. But researchers aren’t sure of the reason for this.

Harris has some advice for both sides in the doctor/patient relationship: Physicians "need to try to keep the conversation focused on the behavior (not the person) and avoid, as much as possible, being perceived as intentionally inflicting shame or guilt."

As for patients, she said: "Think not of what you are but what you can do."

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