Synopsis: Patients often keep lifestyle secrets from their physicians even though it may be harmful to their health. Experts discuss the most common reasons for secret-keeping and the consequences that may result.
Host: Nancy Benson. Guests: Dr. Daphne Miller, family physician, San Francisco; Karen Giblin, President, Red Hot Mamas menopause management program
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Nancy Benson: Most of us can probably admit to keeping a few secrets. Maybe you haven’t told your romantic partner quite everything about past relationships. Maybe you knock off a few pounds when revealing your weight. Or maybe you don’t tell your doctor everything about your bad habits. Believe it or not, keeping secrets from your doctor could be doing you a lot of damage.
Dr. Daphne Miller: One example is someone who has very high blood pressure that I remember and I was doing everything I could to treat them. It turns out that they were actively using cocaine. I could throw every medication in the world at them, but it was the drug itself that was causing these high blood pressures and palpitations.
Benson: Dr. Daphne Miller is a family physician in San Francisco. Some of her patients have kept their habits a secret from her.
Miller: I couldn’t even begin to work with them on their addiction or tackle the addiction and certainly couldn’t work with them on treating the high blood pressure because I didn’t have the information. Not only are they not getting the help that they need in terms of their addiction, but they’re also having this incredibly high blood pressure that is not being treated and could potentially lead to a heart attack or a stroke. So, the ramifications are all over the board. Your doctor is supposed to be your best advocate and is supposed to be someone who helps you both in terms of prevention and also in terms of treatment. I think that both patients and doctors need to work on communication. It needs to be a two-way street and it needs to be a lot better in many instances than it is now.
Benson: Miller has found that many of the secrets that patients keep are behaviors that could trigger a disapproving headshake.
Miller: The most common ones are things that are commonly viewed as social stigmas. Different kinds of risky sexual behavior, drug use, alcohol use, different kinds of addiction are really relevant to your health, like gambling addiction or things that are censored a little bit more by society.
Benson: Miller says behaviors like that may prompt patients to keep quiet simply because they don’t want to be nagged about them.
Miller: There are physicians that find out that someone’s involved in something that is not a great behavior and then proceed to lecture them. I think no one likes to be lectured. So if you’re having that kind of relationship with your doctor you might catch on pretty quickly that that’s how they’re going to react to certain piece of advice and you keep it to yourself rather than receive a lecture.
Benson: Just about anyone of any age may keep secrets from their doctors, but Miller says that studies have confirmed the most avid secret keepers are teenagers.
Miller: It’s compounded. You’re a teenager, you’re up sometimes to more mischievous behavior than most adults and on top of it you have this adult figure sitting there and grilling you. So they did do studies on adolescents and they found it was unbelievably high. Way above 50% of teenagers in most healthcare settings don’t revel information to their doctor about drugs and alcohol use.
Benson: When it comes to adults, Miller says the fear of being denied insurance in the future may also cause dishonesty.
Miller: I can’t help but be aware of how much the insurance companies have to do with the sense of paranoia that if you reveal too much it might come back to bite you in some way. There are instances for sure where insurance gets a hold of information on a patient and contacts that patient directly about it and makes the person realize that there is a big brother watching them.
Benson: But while patients may fret about insurance, at least they don’t have to worry about their doctors blabbing their secrets all over town. Physicians are required to follow privacy guidelines set by the government’s HIPAA law.
Miller: Pretty much anything that a patient tells the doctor by law in terms of HIPAA is supposed to be absolute secrecy and privacy. But you understand that this is a little bit of a murky area because the doctor is writing it into a chart with a diagnosis that then gets submitted to the insurance company in order for the bill to be paid. I think any health group that feels like either they’re going to be judged or that maybe even have the misperception that the information might somehow leak into the community, which would be completely unethical, but sometimes there is that fear.
Benson: So if privacy isn’t a concern, and a person isn’t doing anything that mom or
the sheriff may disapprove of, why do some people still hide their symptoms? Sometimes it’s just good old fashioned embarrassment.
Karen Gibblin: I always say that you need to find a doctor that has an attentive ear because that’s always welcome, especially when you have symptoms that sometimes are very sensitive to talk about.
Benson: Karen Gibblin is the president of the menopause management education program “Red Hot Mamas.” She says that menopause symptoms are a great example of something that doesn’t get shared with doctors, even though 75 to 85 percent of women experience symptoms.
Gibblin: Some women say that some of the physicians really lack social skills and the ability to communicate effectively with women. They often times fail to listen. If they don’t listen that doesn’t allow the woman to communicate effectively.
Benson: However, Glibblin also thinks patients need to understand that when doctors ask really personal questions, it’s for the patient’s benefit.
Gibblin: I would value a doctor that would bring up those concerns rather than a doctor that you go to and in many cases the doctor is on autopilot it feels like. They’re not paying attention to you carefully. But it seems like a doctor that would bring up those health issues is a very valuable resource because you don’t want to find a clinician that’s not paying attention carefully to your health behaviors. So I think that a doctor on autopilot, one that just ignores everything and just looks at your chart is not of real value to a patient. But I think it’s important that the patient turn around and address some of the issues that concern their health.
Benson: Miller agrees. She says it’s important for doctors to ask questions carefully so that they don’t come across as intrusive.
Miller: I think it’s really important for doctors to put their questions in a context, especially when it gets into areas that don’t feel like they are directly relevant to your health. So asking questions about different habits or recreational drug use or even sexual habits. If you ask a patient are you monogamous. That can feel like an incredibly nosy question, but if you explain, “I’m trying to understand what your sexual habits are because people who are having relationships outside their marriage are sometimes more at risk for sexually transmitted infections, then it puts your question in a context and you’re not just a nosy doctor anymore.
Benson: That may make it challenging to be “secret-free”, but Miller says being honest with your doctor may be the only way you get the treatment you really need.
Our writer/producer this week is Victoria Bokios.
Our Production Director is Sean Waldron.
I’m Nancy Benson.