Up to 80 percent of respondents to a 2018 survey said they have lied to their doctor about information that could affect the medical care they receive. When asked why, more than half of the respondents said they were embarrassed. Many others said they did not want to be judged.
Embarrassment is a significant issue for patients, especially for those with digestive problems. Many patients feel shame simply describing their gastrointestinal (GI) symptoms to their doctors, much less risk potential humiliation during the exam or diagnostic tests. Patient embarrassment can have serious consequences on outcomes, as physicians cannot accurately assess a patient’s condition without having all of the facts. Embarrassment can also erode patient trust.
While patients will always feel some measure of embarrassment over certain gastrointestinal conditions and diagnostic tests, such as hemorrhoids and colonoscopies, clinicians can take steps to help patients overcome shame.
Empathy, in general, is the ability to understand and share the feelings of another person. Empathy in medicine has a slightly different, more in-depth meaning, one that requires a conscious, effort to distill the details of the patient experience while withholding one’s own reactions.
Tips for Helping Patients Overcome Embarrassment
Create a private consultation area
Design a space in which patients feel comfortable discussing their condition, without fear of being overheard or interrupted.
Make eye contact
Making eye contact with the patient helps establish a connection, but the use of electronic medical records can make it difficult to maintain eye contact throughout the encounter. Make eye contact at the beginning of the appointment to establish an environment of trust and re-establish eye contact throughout the encounter. When working on the computer, continue conversing with the patient.
Lead the conversation
Some patients may feel too embarrassed to ask questions or bring up concerns, so if a patient seems interested in continuing a conversation but be struggling to find the right words, make the first move.
Require a gown only when medically necessary
Research shows that a hospital gown is “associated with symbolic embodiment of the ‘sick’ role, relinquishing control to medical professionals, and emotional and physical vulnerability for people living with a chronic health condition.” Patients report being required to wear these embarrassing hospital clothes even when not medically necessary.
Reassure your patient that you can understand their embarrassment, and that you are there to help them. Use phrases like, “that must be uncomfortable,” and “we’ll do our best to get you back on track.”
Avoid making light of the patient’s situation, even if you are simply trying to help the patient relax; the patient should never think you are making fun of them.
Practice positive body language
Positive body language helps facilitate verbal communication between you and your patient, especially during embarrassing conversations. Positive body language includes nodding your head, smiling, and maintaining eye contact. Sitting down, rather than standing, demonstrates relaxation and comfort with the patient.
Avoid body language that closes you off from your patient, such as crossing your arms, putting your hand on the doorknob while talking, or turning your back while the patient is speaking.
Avoid a condescending tone
Keep in mind that you come into nearly every conversation with substantially more knowledge about whatever gastroenterological condition the patient may have, and this imbalance can make a patient even more embarrassed about discussing their problem. They might be afraid of mispronouncing something, for example, or uncertain that they are describing their experience coherently.
Create opportunities for the patient to speak
It takes courage to make an appointment for an embarrassing medical problem, and even greater daring to keep the appointment. When it comes time to utter the embarrassing words, the most apprehensive patients may panic and clam up. Research shows these awkward pauses can have a negative effect on the conversation. While it may be tempting to fill in uncomfortable silences with small talk or helpful information, a deluge of trivialities, unwanted statistics or medical data can make your patient even more uncomfortable.
If your patient suddenly goes quiet while discussing a potentially embarrassing problem, re-establish the conversation gently. Ask the patient a question about their GI symptoms, for example, particularly if the patient seems to have left out some details.
Employ active listening skills
Active listening conveys respect for the patient’s self-knowledge, which can make the patient feel more at ease. It also helps ensure the physician does not miss pertinent information about the patient’s GI symptoms or mistakenly provide an ineffective or undesired treatment plan. Having meaningful conversations with patients also builds trust. Active listening puts gastroenterologists in a position of trusted intermediary.
Features of active listening include:
- Being neutral and non-judgmental
- Asking questions
- Requesting clarifications
- Making statements that reflect what the patient says
Demonstrate curiosity about your patient
Asking questions can help physicians understand more than just their patient’s presenting issues, and may provide insight into the issues they are too embarrassed to bring up. Ask patients how their GI symptoms affect their lives, for example, and learn about other factors that might be affecting their overall health.
Gaining an in-depth understanding of patient embarrassment can help gastroenterologists improve the care they provide. Clinicians can identify ways to improve patient trust by making small modifications within their own practices, conversation skills, and body language.