Ashamed after a doctor's visit? it could be due to self-contempt

Ashamed after a doctor's visit? it could be due to self-contempt

Chances are when you visit your doctor, whether it is for an illness or to discuss a new diet plan, you are probably going there with the aim of feeling better. But research suggests that around 50% of us feel guilty or ashamed when we leave a doctor's appointment.

A 2009 study conducted by Christine Harris, professor of psychology at the University of California, San Diego, first identified that over half of patients experience guilt or shame when they leave a doctor's office.

Common triggers of these feelings in patients included conversations with doctors about sex, weight, alcohol or substance abuse, and failing to take prescribed medication or to follow doctor's instructions.

But two new studies, published in the journal Basic and Applied Social Psychology and led by Harris and co-authors Ryan Darby and Nicole Henniger, also of UC San Diego, have investigated the consequences of these feelings.

According to the researchers, "more than one-third of all deaths in the United States are still essentially preventable and largely due to unhealthy patient behavior," meaning that it is important to understand how patients react to a doctor's visit that causes guilty or shameful feelings.

The first study involved the analysis of 491 undergraduates from UC San Diego. In this study, the researchers asked the subjects about any shameful feelings they may have experienced when interacting with their doctor.

The second study analyzed 417 subjects aged between 18 and 75 years who were from a variety of socioeconomic backgrounds. These participants were asked questions about feelings of shame and guilt during doctor's visits.

Reactions include avoiding doctors or making lifestyle changes

The investigators found that in both studies, participants felt the most shame when talking about sex and weight, while the topic of teeth was flagged as highly shameful for younger subjects.

Researchers say many of us may feel guilt or shame after a doctor's visit because of our own self-contempt.

Other shame-provoking topics included smoking, mental health, failing to take doctor's orders or prescribed drugs, and alcohol and substance abuse.

Harris notes that subjects commonly reported encounters with dentists, family practice doctors and gynecologists as being the most shameful experiences, most likely because people tend to visit these health professionals more than others.

When looking at the subjects' behavioral reactions, the researchers found that this was largely varied. Some participants reported avoiding doctors completely, while others adopted major lifestyle changes in order to better their health.

Furthermore, the researchers found that women reported feeling shame and guilt during doctor's visits more than men. Harris notes that this may be because women perceive engagement with their doctors differently, or doctors may adopt different behavior when talking to women.

Reaction to shame 'dependent on self-contempt'

Harris says patient reactions are dependent on whether they "condemn their entire self" for the behavior that has led them to feel shame, or whether they put focus solely on the behavior itself - an attitude that is likely to result in better outcomes.

She explains:

People who report a more positive reaction focus in on a bad act, not a bad self. Capacity to change mediates the response.

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.'"

Furthermore, the investigators say a patient's response is also dependent on their perception of the doctor's intentions.

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

In order for doctors to improve patients' reactions to conversations between them, Harris says "doctors 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."

And she says patients must focus on what they can do to improve their health outcomes after a doctor's visit, rather than negative feelings about themselves.

Late last year, reported on a study suggesting that a disconnect between patients and doctors can impact weight loss interventions.

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Section Issues On Medicine: Psychiatry