During my time as a registered nurse, I once cared for a woman in her late fifties (with identifying details changed) who had spent nearly a year adapting to symptoms she never thought signaled something serious: body aches, fatigue, frequent nighttime urination, constant thirst, breathlessness, and headaches. Each time the pain flared, she visited a local clinic, received an injection, felt better within hours, and returned to her life. Weeks later, it happened again.
Eventually, she came to the facility where I work as a registered nurse. Over three visits, her blood glucose readings ranged from roughly 220 to 290 mg/dL. As a nurse, I am not authorized to diagnose or prescribe, so I referred her for specialist evaluation and recommended an HbA1C test. It came back above 9 percent, evidence of months of poor glucose control and a strong indication of an underlying chronic condition.
Her story isn’t unusual. Around the world, people delay care for many reasons, including psychological factors, social pressures, financial limitations, and gaps within health systems. The delay wasn’t hers alone to own, either. Her symptoms developed gradually and, early on, looked nonspecific enough to explain away. In busy clinical settings, immediate relief is often the most practical priority in the moment, and a fuller picture only emerges once more symptoms accumulate.
Part of what kept her from acting sooner was how she made sense of what she was feeling. She attributed her fatigue to hard work, her aches to aging, and her nighttime urination to drinking more water. Psychologists call this symptom appraisal, the process of noticing and explaining bodily changes. The Common-Sense Model of Self-Regulation describes how people build their own understanding of illness by asking what’s happening, what caused it, and whether they can control it. Because her pain eased after each injection, she concluded the problem was minor and temporary, even as the underlying disease progressed.
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But recognizing that something might be wrong doesn’t automatically lead to care-seeking. The Health Belief Model explains why: People weigh perceived risk and severity against the barriers in front of them. For her, traveling to a referral facility meant transportation costs, lost income, and rearranging household duties. Against those immediate costs, an uncertain future diagnosis felt abstract. Repeated counseling eventually got her to complete the HbA1C test, but referral alone rarely closes that gap.
Three psychological patterns reinforced her wait. First, there was optimism bias. It’s the tendency to believe misfortune happens to other people, meaning she had seen relatives live with diabetes and still couldn’t ideate that it could happen to her too. Secondly, present bias led her to keep choosing the option that solved today’s pain over the one that might prevent tomorrow’s complications. And beneath both was fear: what psychologists call fear avoidance, or, when it specifically concerns test results, diagnostic avoidance. She postponed her referral repeatedly, telling herself “next month,” because avoiding the appointment quietly reduced her anxiety, even though it did nothing to slow her disease.
Social and financial factors reinforced the delay, too. Like many people in resource-limited communities, she also sought care from traditional and faith healers and used a community-recommended herbal remedy, not out of distrust of modern medicine, but because these options were familiar, trusted, and affordable. Financial pressure and household responsibilities continued to slow her path to specialist care even after her lab results were abnormal. A test result doesn’t complete a diagnosis. Patients still need to reach services, understand results, and access ongoing treatment, and each step can be interrupted.
The stakes of that delay are real. Months of poorly controlled blood glucose raise the risk of cardiovascular disease, kidney damage, nerve injury, vision loss, and poor wound healing. Many of these complications are preventable with earlier diagnosis, appropriate treatment, and sustained disease management. This pattern holds across many chronic diseases. Caught early, they are easier and cheaper to treat. Caught late, they cost patients and health systems far more.
Her story suggests a different way of listening. For patients, this means recognizing that temporary relief does not always mean the problem has gone away. Repeated symptoms deserve attention, not just repeated short-term fixes. For families, it means encouraging a checkup without judgment and offering practical help, such as a ride or a few hours of childcare. For clinicians, it means exploring how a patient understands their own symptoms, and asking about the financial and emotional barriers standing between a referral and a completed evaluation.
Sometimes the most useful question is also the simplest: “What do you think is causing these symptoms?” The answer can surface a belief that has quietly delayed care for months, and it may be the first step toward helping someone get the care they need. Avoiding a diagnosis doesn’t prevent illness; it only postpones the chance to treat it. Compassion, far more than criticism, is what moves people from avoidance toward action.
Kainat Hikmat is a nurse.
