Angel Piping to the Souls in Hell

What Happens When Providers Judge Patients?

Trust and vulnerability are two closely related dimensions of the relationship between healthcare providers and patients. Trust arises from vulnerability, wrote Mark Hall. But when providers judge patients, they violate that trust. New research in JAMA Network Open tells us that this breach of trust might be relatively common. And it has serious consequences.

That’s because patients frequently withhold important information from their providers. And the most common reason for doing that is a fear of being judged.

Holding Back

This research, led by Andrea Levy, showed that most patients withhold information that’s important for their clinical care. In one sample, it was 61 percent that held back. In another, it was 81 percent. Most often what they held back was the simple fact that the patient disagrees with recommendations of the provider. Next most common was being unable to understand instructions from the provider.

Think about it. How can a patient get good healthcare if they disagree with their provider, but can’t say so? Or even worse, if they don’t know what they’re supposed to do. As many as 81 percent of these patients hold back because they don’t want to be judged or lectured.

But It Doesn’t Work

In people with overweight or obesity, holding back doesn’t guarantee a patient will avoid that feeling of being judged or getting a lecture. In fact, Kimberly Gudzune and colleagues found that one in five patients with BMI ≥ 25 feel judged. They also found that patients don’t trust their providers if they’re feeling judged. It’s a circular problem that’s hard to escape. The result is worse health.

In our experience, a simple misperception often lies at the root of these harsh judgments. Many healthcare providers simply do not understand or will not accept the fact that obesity is a highly heritable disease. People don’t opt in, they inherit a genetic profile that puts them at risk. Then, our food supply, our physical environment, and other factors do the rest. Choice is important, but mainly in terms of what the patient chooses to do about this disease that they never wanted in the first place.

That’s when our healthcare systems make things worse. Providers offer blame when they should offer care. Payers make it hard to access evidence-based care. It all starts when providers judge patients.

Click here for the study by Levy et al.

Angel Piping to the Souls in Hell, painting by Evelyn De Morgan / WikiArt

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January 17, 2020