Adesso!
The FIERI Boston Newsletter
Edizione Giugno 2001

Why Do People Avoid Doctors?
by Dino Messina, MD, PhD

I thought this article might be interesting to the Fieri faithful. I am prompted to write this to encourage people to seek care when they are uncertain about their own health or more often the care of those around us who may be elderly, speak another language or be fearful of seeking help for other reasons. I have experienced this in my own practice. A woman notices a lump in her breast but keeps it to herself. She doesn't tell her family members nor her friends. She avoids her physician until one day she develops a bad case of diarrhea. By that time she is so severely dehydrated she is forced to seek medical care and it's determined that she has metastatic breast cancer. She dies six months later. The situation otherwise could have been entirely different had the lady sought medical care earlier she most likely would still be alive today. The survival rates for breast and other types of cancer are slowly improving with early detection and newer treatment modalities.

There are many other cases of people avoiding medical care. A friend of mine (a physician himself) almost died of pneumonia because he waited too long to be seen. He showed up in the ER after feeling terrible for a week. He was immediately intubated put
on a ventilator) and sent to the Intensive Care Unit, he came close to death but fortunately survived. He is now a professor of medicine and an Intensive care physician himself in New York. The experience changed his life.

There are other examples of people too busy to get annual exams, using home remedies or simply avoiding medical care altogether. What makes people avoid care? Is it fear of the unknown, are people too busy? At a time when there is a wealth of information available to the general public, people in larger numbers than ever before are reluctant to seek care. What's up with that?

There are studies showing that people who have vices like smoking put off appointments to avoid healthy living lectures by their doctors, others are so unrealistically optimistic they are convinced that no matter what they do to themselves they will be ok. Some are just plain old embarrassed to discuss their symptoms with their doctor. If anything comes out of these studies its a sense of a multitude of reasons why we avoid health
care providers.

The bottom line appears to be fear.

The apparent reason for this dread of the doctor, experts say, is the breakdown of the doctor-patient relationship. People see a different provider when they go to their doctor's office, or their doctor is no longer available. he patients themselves may have just moved to a new city. here was a time when people could go see their trusted doctor to confide in, the doctor would be willing to help at any time, even though a house call may be needed. Now with the mess we have that is called a health care system there has been tremendous breakdown of the once revered doctor patient relationship. The stability of the doctor patient relationship, which is the core of trust, has eroded. It's a reflection of our society - we move, families separate, employers change insurance plans and the beat goes on. I am part of the problem myself, as I now find myself working with migrant farm workers in Washington to try and make a better life for these hard working immigrants. They are trying to make a better life for themselves, just like grandma and granddad when they came here from Italy. (We are the richest country in the world and I am totally ashamed to be part of a system that does not provide health care to all of its citizens. This is a topic that really pisses me off and I could go on for a long time discussing why I voted for Ralph Nader but I won't).

I hope this article brings to light any personal issues that may have prevented some of us or those we know from seeking help. My long term hope is that we are able to return to a more compassionate health care system, that we become more communal, like the small towns in Italy, where there is a great sense of community. I also pray that people re-establish faith in their physicians, hospitals and so called leaders of our society,

salud y cient ` anni.
Dino Messina MD PhD