Feeling judged by your doctor? You might be right

When an individual visits their doctor, they aren't supposed to keep secrets. Unless patients are forthcoming about their symptoms, behaviors, and health-related beliefs, it's hard for health care professionals to effectively diagnose and treat illnesses—or to advise and educate patients about how to take better care of themselves in the future.

There's only one problem: new research from Stevens Institute of Technology shows that many people believe they may be judged if they share mistaken beliefs with their care team—and that doctors really do take strongly negative views of patients who disclose incorrect or unreasonable beliefs.

"People worry about their doctors looking down on them—and it turns out that's an entirely rational concern," says Dr. Samantha Kleinberg, the lead researcher on the project. "Our study suggests that doctors really do judge patients harshly if they share information or beliefs that they disagree with."

To understand how people think about sharing information with health care professionals, Dr. Kleinberg and her collaborators surveyed over 350 patients and over 200 physicians, asking how they would view people who held a range of different medical beliefs. Beliefs ranged from true information to incorrect statements of many types: some were reasonable (like believing that eating sugar causes diabetes); some were unreasonable (like believing that carrot juice cures diabetes); and some were conspiracy theories (like believing that pharmaceutical companies deliberately cause diabetes to create more customers for insulin). Dr. Onur Asan, also at Stevens Institute of Technology, co-authored the study along with Dr. Jessecae K. Marsh, a collaborator from Lehigh University.

"The degree to which health care professionals held negative perceptions towards patients espousing misinformation surprised us, and suggests doctors may need additional support and resources to effectively treat such patients," says Dr. Asan.

The more unreasonable a person's health beliefs, the more negatively they were viewed by both laypeople and health care professionals. "We found that our subjects viewed people negatively if they held mistaken beliefs—but viewed them much more negatively if they held more unreasonable or conspiratorial beliefs," Dr. Kleinberg says.

Surprisingly, however, there was little difference between the responses of doctors and laypeople or patients with personal experience. Even patients living with chronic health conditions, who were familiar with the complexities of health care, were highly intolerant of people who held mistaken beliefs, the team found. "We'd thought people who had diabetes themselves might be more sympathetic, but it wasn't the case at all," Dr. Kleinberg says.

Physicians were also highly likely to view people negatively when they expressed mistaken beliefs about health-related topics. "That was a surprising result, and frankly a depressing one," Dr. Kleinberg says. "Laypeople aren't expected to have medical expertise, so doctors often have to correct mistaken beliefs on health issues. That shouldn't be something that leads doctors to view patients more negatively."

Surveys show that the majority of people hold at least some incorrect health-related beliefs, such as the false belief that taking vitamin C will cure their cold, or that eating a sugary snack can directly cause diabetes, making it all the more important that people feel free to solicit expert opinions. "We rely on our doctors to educate us and help us overcome these medical misconceptions—but that's only possible if we're able to express our ideas freely, without fear of being judged when we get things wrong," Dr. Kleinberg says.

Part of the problem is that it isn't usually possible for laypeople to know whether their own beliefs are correct or incorrect, or whether they will be perceived as reasonable or unreasonable. That means patients are likely to withhold even true and reasonable beliefs in order to minimize the risk of being viewed negatively by their doctor.

More research is needed to explore the ways in which these negative perceptions impact real-world patient-doctor interactions, Dr. Kleinberg says. Still, she adds, it's clear that physicians need to be doing more to make their patients feel safe and comfortable during routine interactions.

"If we want to have clear communication between patients and health care professionals, we need to change the way that doctors think about patients who are misinformed," Dr. Kleinberg says. "Doctors need to overcome their tendency to judge patients, and actively encourage patients to share their thoughts—even their incorrect ones—much more freely than they currently do."

The paper is published in the journal Medical Decision Making.