When the thought of getting health care makes you sick.
Not knowing what will happen at the doctor can frighten some anxious patients.
If you’re like most people, you don’t exactly love visiting the doctor. But for some, the anxiety they experience is so overwhelming they avoid any form of health care whatsoever – in some cases for decades.
David Yusko, clinical director at the University of Pennsylvania‘s Center for the Treatment and Study of Anxiety, treats patients with iatrophobia – the medical name for fear of doctors. He says the phobia probably affects about 3 percent of the population.
Such people can be helped by exposure therapy – in which they’re gradually confronted with medically related images, items and scenarios in rising order of fear-provoking power.
When Yusko treats these patients, he says their anxiety is obvious: “They’ll wring their hands; they’ll cross their arms or legs; or they’ll try to turn their body away from the image or hide their eyes from it. They’ll talk about their heart beating quickly, their hands getting sweaty and feeling dizzy or nauseous.”
Cascade of Fear
The biggest fear for many patients is fear of the unknown, says Andrew Rosen, director of The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida. Needle phobia is also common, Rosen says, above and beyond the distaste most people have when faced with an injection or blood draw. When he talks patients through exaggerated fears, it often turns out they’ve imagined excruciating pain that could last for hours.
“The person doesn’t know what’s going to happen to them once they step in the door. Usually a person who’s anxious fills in the blanks with bad things: ‘I’ll be hurt.’ ‘I’ll be mistreated.’ ‘I’ll be diagnosed with some terrible disease,’” Rosen says. “It’s the fear of pain, bad news, cancer, the hospital.” It’s a cascade in which a patient could go “from A to Z in two seconds,” he adds.
Anticipation Equals Dread
Doctor anxiety wasn’t an issue for Virginia Lounsbury, of Gulf Stream, Florida, until 2009, when she was hit with a debilitating illness at age 38. She underwent a barrage of treatments and multiple hospitalizations until the life-changing diagnosis – postural orthostatic tachycardia syndrome, or POTS, a rare genetic condition – came 2.5 years later.
By then, she had developed a full-blown fear of doctors and health care facilities. It reached the point where she needed help managing her anxiety, which brought her to Rosen’s center.
Rosen walks Lounsbury through scenarios in advance, starting with her rising anxiety as the car enters the parking lot and she approaches a medical center. “It’s a building – it’s concrete,” she recalls him saying. “You can’t be afraid of concrete.”
Because she’s claustrophobic, spending 90 minutes in an MRI tube is among her least favorite experiences. But for Lounsbury, the waiting room is the hardest part. “All those TVs [are] on – any doctor you go to,” she says. “And it’s all this medical news, which is never good.” She describes hearing dire cancer statistics emanating from a TV as she once waited her turn for a mammogram.
To cope with future visits, she and Rosen came up with a plan: Pack a bag with items for distraction, find a quiet waiting room corner away from the intrusive TV and read, do needlepoint or check email.
Ah, the Dentist
One underlying cause of doctor fear is the increasingly impersonal nature of health care, according to Rosen. But when it comes to dental care, the experience may be too personal.
“If I’m going to work on you as a dentist, I’m going to get pretty close,” says Matthew Messina, consumer advisor for the American Dental Association. “There’s kind of that invasion of personal space aspect. So I have to respect that in patients.”
With extremely phobic patients, he says, most have had some bad experience recently or in the past, perhaps with a dentist or while in the hospital, and the memory could be long repressed. “They may have been restrained in the emergency room,” he says. “Those kinds of things can create very deep-seated fears where dentistry and medicine all sort of get lumped together.”
Messina, who has a private practice in Fairview Park, Ohio, says he wishes dentist avoiders would put aside their fear long enough to sit down in his office – just to talk. “We have to confront the fear and name it,” he says. “Then we can have a chance at overcoming it.’”
Motivation to Change
Getting someone with extreme fear back into the health care system is a hard sell. Rosen recalls a patient in her 50s who hadn’t had a breast cancer screening or seen a gynecologist in 25 years.
For some patients, it takes a crisis like a heart attack or appendicitis to accept treatment. Others finally acknowledge the need for preventive care and routine screening. Yusko says he’s had several cases of women whose plans to eventually have children motivated them to overcome their medical fears.
Exposure Therapy in Action
With exposure therapy, Yusko says patients confront a hierarchy of anxiety in the safe, supportive environment of his center. Images – of stethoscopes or syringes, for instance – would be lower-hierarchy items. From there, therapy could move on to viewing videos or TV shows like “Grey’s Anatomy” that feature medical procedures.
Next, the patient might stand outside the hospital in the parking lot. Actually seeing a needle, or being in the same room as a needle, would be another step. And because a nurse works in the center, Yusko says patients get a chance to come face to face with a medical professional.
Other Treatment Options
Different types of talk therapy and relaxation techniques may also help. While medications can ease short-term anxiety, they don’t address the root of the doctor phobia and most often aren’t needed, physicians say.
With dentistry, the situation is somewhat different. Messina says some patients may benefit from techniques including medication, biofeedback and hypnosis. For procedures like wisdom-tooth removal, sedation may be warranted, he says, but there is a risk-benefit ratio involved, and “using sedation to clean someone’s teeth [is] probably a higher level of medical risk than we’d like to take on.”
Dealing With It
Of their patients who’ve gone through exposure therapy, the vast majority can now manage their anxiety and receive medical care, Yusko and Rosen say.
Lounsbury, who’s started a foundation to help others with her condition, says she’s coping better with her anxiety. Acupuncture works for her (for those scared of needles, laser acupuncture or acupressure are alternatives). To people who share her fears, she offers these words of encouragement: “The main point is, wherever you are, it’s only temporary. Nobody’s ever gone to the doctor forever.”