At the close of each year, insurance companies and health care providers give patients an opportunity to change their coverage through “open enrollment.” Open enrollment coincides with the personal goals of many to improve their health by cutting out harmful habits and taking measure of their overall health through annual assessments and tests. Increasingly, this end-of-the-year ritual fosters a level of dread or anxiety for those who do not trust or feel intimidated by health systems. Many of the health disparities facing the African American community have roots in a distrust of physicians or the lack of quality care they believe they are receiving (real or perceived) based on race.
Much of this fear surrounding health care has been squarely documented across racial, ethnic, and socioeconomic lines. For instance, a 2017 Mayo Clinic report found that millions of Americans suffer through “hostage bargaining syndrome” in the company of doctors. Hostage bargaining syndrome is a form of fear and anxiety in the presence of health care professionals that leads patients to mask symptoms, attempt to ingratiate themselves to those who must care for them, or remain silent when they need assistance to avoid “bothering” or “upsetting” nursing or hospital staff.
One study respondent gave this example, which is considered a textbook example: “Immediately after undergoing major abdominal surgery, I overheard a nurse label me as “difficult” when I refused an attempted blood sample draw until I felt that my pain was more adequately controlled. I sat, wordless, as the surgical team she summoned interrogated me about my home pain regimen (there was none). I felt hopeless as they attributed my pain to an imagined tolerance to opioids. In that bed, in pain, I felt terribly, frighteningly vulnerable, dependent on strangers for my most basic needs in addition to their complex care. I felt powerless in a way that is impossible to imagine when one is in a privileged position of wholeness and well-being. I know this because after that comment, I pathetically tried to ingratiate myself to the care team,” the respondent noted. “I suppressed my fear and sadness, and attempted to make small talk with people who just moments earlier had made me feel belittled and somehow ashamed. I offered compliments and commiserated about burdensome charting responsibilities and unwieldy patient assignments. I believed that I needed to make them like me in order to receive their best care—in effect, to earn pain control through good behavior. I felt I had to prove to them that I was deserving.”
While the relationship between patient and physician requires open communication, it also demands an embrace of the Hippocratic oath to “do no harm,” as well as a bedside manner that recognizes that a person experiencing illness is vulnerable and weak.
Delia Lunger, a retired orthopedic surgeon said that she always found ways of making her patients feel comfortable and took extra time to ask about their sleeping habits, fears, and worries, to ensure they were comfortable enough to discuss their health in detail.
“We have other people’s lives in our hands and they are depending on us to not only do the job, but to be caring and loving in our engagements. With managed care, physicians are encouraged to see a set number of patients in a given time period; that is not always tenable,” Lunger said.
She said she often ran over scheduled appointments and worked into the late evenings to ensure every patient was seen and felt comfortable with the quality of care they received.
“When selecting a new physician, it is important to ask around about the doctor’s bedside manner – how much time do they spend with patients? Do they listen intently to the needs of the patient or are they overtalking them or assessing and writing prescriptions without a full picture? The other side of the coin, which is very important, is that patients must be open, honest, and persistent with having their health needs addressed. You cannot leave a physician’s office without a satisfactory treatment program or care solution.”
This Washington Informer health supplement encourages readers to find the help they need and address the fears they may have in seeking treatment. Being the best “you” possible requires taking charge and disrupting disparities.
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