The Psychology Behind Medical Care Avoidance

Apr 29, 2022 at 04:38 pm by pj


By APRIL BOYKIN, LCSW

Health care avoidance is a type of patient disengagement that impedes an individual's health behaviors or causes them to delay obtaining health care, and thus can negatively influence well-being. According to the NIH and other sources, 30 percent to 40 percent of people report avoiding medical care even when they think they should go to a doctor. As medical providers, we know that health outcomes are greatly improved when patients comply with medical recommendations, maintain regular health care schedules, and seek help right away when experiencing concerns about their health. Unfortunately, many of our patients avoid care and only show up when they are in an acute situation. As a result, they experience a worsened prognosis, have fewer treatment options, and have more difficulty responding to treatment, especially in the areas of mental health, heart disease, strokes, cancers, arthritis, urinary incontinence, and infectious disease. When the avoided healthcare is finally accessed, more radical treatment is often required, hospital stays are prolonged, institutionalization may be necessary, and there are higher associated costs. Understanding the psychology behind medical care avoidance can improve health outcomes and decrease costs.

 

What causes avoidance of healthcare? Many of the causes are apparent; lack of adequate healthcare coverage, costly copays, out-of-pocket expenses, lack of access to providers in a geographic area, and time constraints all keep people from seeking care. In 2018 NORC found that a significant number of people are more afraid of the cost of medical care than they are of a severe illness. All these reasons are substantial and create a Public Health Crisis in themselves. But there are other reasons for medical avoidance, which we will explore in this article. Many people who avoid medical care suffer anxiety, fear of death, and fear of being diagnosed with a life-altering condition, among other things. These fears are pervasive and debilitating and cause mental and emotional anguish as people struggle to reconcile fears of being ill with fears of seeking treatment.

 

Who makes up medical avoiders, and what are the reasons? In “Predictors of Avoiding Medical Care” (Medical Care Journal 2014), the authors found that people who avoid medical care are characterized by low health self-efficacy. They tend to have less experience with quality care, have difficulty expressing concerns, and fail to get help to resolve their uncertainty about their health. Frequently they do not have their fears attended to by a medical provider. They frequently have no consistent primary care physician, have a negative self-concept, engage in risky behaviors like smoking or drinking, and have a fatalistic attitude about cancer. They also reported that the reasons for avoiding medical care are: preference for self-care or alternative care, dislike or distrust of health care providers, fear or dislike of medical treatments, time and money, the experience of prejudice in healthcare, discomfort with body exams or body-shaming experiences, fear of having a severe issue or hearing bad news, and thoughts of dying. 

 

It is apparent that for medical care avoiders 1) feeling as if they have no control and are not understood, 2) past negative medical experiences or trauma, and 3) being discounted due to prejudices, weight, or risky activities are the most common categories we should address to improve patient health outcomes.

 

Interventions to prevent patient delay in obtaining healthcare and improving health outcomes:

 

No control or Not Understood:

 

Past Experiences

 

Discounted:

 At some point most of us have put off or skipped a procedure, and then fought with our own fears to reel ourselves back in to medical compliance and good self-care. Realistically, not everyone can. If you have patients that have high anxiety around any healthcare issue, procedure, or compliance, please don’t forget the benefit of counseling. There are trauma reducing techniques, phobia protocols, and other tools that mental health practitioners have that will help patients manage their fear and help them become more actively engaged in their own healthcare.

 

April Boykin is a Licensed Clinical Social Worker and cofounder of Counseling Resource Services (CRS). Established in 2013, CRS is a community-based in-home integrated behavioral health agency serving the aged and disabled population in Central Florida. As a mental health counselor, she has provided individual, family and caregiver counseling to children, teens and adults.   She can be reached at april@counselingresourceservices.com

 

Sections: Volusia-Brevard Local News North Central Florida Local News Clinical