Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Self-censoring of patient information may be a public health hazard

Steven Reidbord, MD
Physician
March 30, 2014
Share
Tweet
Share

Medical student Joyce Ho recently wrote an article in which she admitted to discomfort raising the topic of religion with patients.  As a “polarizing” issue that could make the doctor-patient relationship “more unprofessional,” Ms. Ho imagined that patients would fear playing into their doctors’ prejudices, particularly if the doctor were atheist, and that this fear would push some patients away from the inquiring doctor.  Despite her instructor’s recommendation to ask gentle, open-ended questions about faith and spirituality in the context of a patient’s support systems, “personally, I still will not actively ask about religious preferences if the patient does not bring the issue up.”

As a new reader of KevinMD.com, I was first to comment — a mistake, in retrospect.  I imagined her concerns were merely new-doctor jitters, a phenomenon as old as medicine itself.  I pointed out that students at first find religion, sex, and many other topics difficult to broach with patients.  Yet uncomfortable topics such as these are often important, and may go unmentioned unless the doctor asks.  Trying to be supportive, I noted that patients usually worry less about a doctor’s own religious beliefs, or lack thereof, than they do about their doctor’s care and concern.  Frankly, I didn’t imagine my comment was controversial in the least.

To my dismay, comment after comment followed that a patient’s religion is none of his or her doctor’s business.  To some extent this was conflated with complaints of unbidden chaplains appearing at hospital bedsides, and awkward offers by medical staff to pray with a patient who wanted no such thing.  But even leaving aside those obvious blunders, there was rampant mistrust of doctors even inquiring about religion, spirituality, or faith.

Apparently, Ms. Ho was right.  Commenters on the blog assumed we doctors jump to false conclusions — “assume certain things about certain religions” — and are apt to over-interpret based on limited information; that we are “busybodies” to ask about such matters; that the information is irrelevant at best; that “doctors might judge you”; and that we cannot help but oversimplify the beliefs of any patient who has given religion or spirituality serious thought.  A self-identified atheist living in the Bible Belt was grateful no doctor had ever asked: “We in the South have enough problems … without also having doctors who think they should be discussing religion with their patients …”  The comment with the most “agrees” was this anonymous one-liner: “I wouldn’t want my doctor asking about my religion. That’s not necessary. I’m glad mine don’t do that.”

How has it come to this?  Haven’t patient advocates and caring doctors fought for years — decades — to retain humanism in a medical system that inexorably drifts toward the impersonal and mechanical?  What happened to the hope, if not expectation, that one’s doctor sees the person behind the symptoms, the whole patient?  And what on earth happened to the premise that one’s doctor can be trusted with sensitive personal information?  Religion, after all, is hardly the riskiest thing one might tell a physician in confidence.

A close look at the commentary reveals the sad truth.  The healing doctor-patient relationship is no more.  The Bible Belt atheist sees religion as a source of doctor-patient antagonism.  For the rest, the patient’s relationship is not to a doctor, but to a “system of care.”  This system aims to fill blanks in an electronic record; one commenter advised doctors to ask, “Would you like me to list a religious affiliation?” in order that this particular blank can be left unfilled if the patient desires.

Of course, antagonism and “listing” a religion in a database are not why medical students learn to take a patient’s social history, including hobbies, interests, and social supports secular and otherwise.  It’s to know their patients as people, to build rapport, to honor beliefs and relationships their patients hold dear, to appreciate their patients’ strengths as well as weaknesses.  It’s to offer personalized counsel, so that (to take the most basic example) the non-religious are not advised to seek solace in church, nor the faithful to neglect it.

Occasionally it’s to develop a differential diagnosis for a medical condition unexpectedly related to a patient’s social interests or behavior.  And often it’s to learn a patient’s values and preferences regarding end of life care, so that when that patient is unable to express them, his or her trusted doctor already knows.

All of this applies to a doctor, a well-meaning, trustworthy (if fallible) human fiduciary who listens in confidence.  In stark contrast, systems of care suffer diffusion of responsibility.  They spread personal information in unpredictable ways, outside the patient’s control and awareness.  Thus, one commenter wrote, “I don’t want that kind of information in my medical record,” while another elaborated, “Blue Cross and the x-ray technician and everyone else who comes in contact with the chart have no need to know what religion the patient is unless the patient chose to share it with everybody.”

Health reform provides long overdue expansion of health coverage.  On the supply side, it promotes systems of care to enhance efficiency and decrease costs.  It’s important to realize what we may already be losing in the bargain: The traditional personal relationship with a physician entrusted to handle intimate details of one’s life with discretion and wisdom.  If it is no longer safe to divulge one’s religion, what about one’s sexual habits, recreational drug use, risky hobbies, and myriad other touchy subjects?

Widespread self-censoring of this information, to prevent it from entering large medical databases, may turn out to be more hazardous to public health than all the inefficiencies of the old approach.

Steven Reidbord is a psychiatrist who blogs at Reidbord’s Reflections.

Prev

MKSAP: 24-year-old woman with painful muscle spasms

March 30, 2014 Kevin 0
…
Next

4 keys to manage medical malpractice stress syndrome

March 30, 2014 Kevin 8
…

ADVERTISEMENT

Tagged as: Primary Care, Psychiatry

Post navigation

< Previous Post
MKSAP: 24-year-old woman with painful muscle spasms
Next Post >
4 keys to manage medical malpractice stress syndrome

ADVERTISEMENT

More by Steven Reidbord, MD

  • Incurable psychiatric disorders: Should we offer palliative care or medical aid in dying?

    Steven Reidbord, MD
  • How drug prices are manipulated

    Steven Reidbord, MD
  • Which is better: Psychotherapy using video or in-person while wearing masks?

    Steven Reidbord, MD

More in Physician

  • Why more doctors are choosing direct care over traditional health care

    Grace Torres-Hodges, DPM, MBA
  • How to handle chronically late patients in your medical practice

    Neil Baum, MD
  • How early meetings and after-hours events penalize physician-mothers

    Samira Jeimy, MD, PhD and Menaka Pai, MD
  • Why medicine must evolve to support modern physicians

    Ryan Nadelson, MD
  • Why listening to parents’ intuition can save lives in pediatric care

    Tokunbo Akande, MD, MPH
  • Finding balance and meaning in medical practice: a holistic approach to professional fulfillment

    Dr. Saad S. Alshohaib
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Online eye exams spark legal battle over health care access

      Joshua Windham, JD and Daryl James | Policy
    • FDA delays could end vital treatment for rare disease patients

      G. van Londen, MD | Meds
    • Pharmacists are key to expanding Medicaid access to digital therapeutics

      Amanda Matter | Meds
    • Why ADHD in women requires a new approach [PODCAST]

      The Podcast by KevinMD | Podcast
    • AI is already replacing doctors—just not how you think

      Bhargav Raman, MD, MBA | Tech
    • Why doctors must stop ignoring unintentional weight loss in patients with obesity

      Samantha Malley, FNP-C | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 19 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Online eye exams spark legal battle over health care access

      Joshua Windham, JD and Daryl James | Policy
    • FDA delays could end vital treatment for rare disease patients

      G. van Londen, MD | Meds
    • Pharmacists are key to expanding Medicaid access to digital therapeutics

      Amanda Matter | Meds
    • Why ADHD in women requires a new approach [PODCAST]

      The Podcast by KevinMD | Podcast
    • AI is already replacing doctors—just not how you think

      Bhargav Raman, MD, MBA | Tech
    • Why doctors must stop ignoring unintentional weight loss in patients with obesity

      Samantha Malley, FNP-C | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Self-censoring of patient information may be a public health hazard
19 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...