Fear in Healthcare

Blog post by Colin Hung.

Since the next HCLDR chat falls on the night before Halloween, I thought it would be appropriate to talk about the parts of healthcare that scare us – as patients, as clinicians, as administrators and as people who work in the industry. Who doesn’t like a good scare on Halloween?

Fear is prevalent in healthcare. Patients fear getting an unexpected disease diagnosis as well as the big hospital bills to treat it. Clinicians are afraid of being sued when patients have a bad outcome and some are scared of mental or physical assault at their workplace. Administrators are terrified of “rocking the boat” and do not speak up when they see something wrong. Fear is everywhere in healthcare.

Fear of Medical Bills

One of the biggest fears for US citizens is unexpected medical bills. According to a recent poll by the Kaiser Family Foundation, 67% of people worry more about unexpected medical bills than they do insurance deductibles, prescription drug costs, rent, food and gas.

A story from the summer perfectly encapsulates this fear. A 45-year-old woman in Boston had her leg trapped between the train and the platform. According to witnesses, the cut on her leg went all the way to the bone. Despite the seriousness of her injury she pleaded with fellow passengers that rushed to her aid not to call an ambulance because she was afraid she would not be able to afford it. The story was first reported by the Boston Globe.

There is no doubt that medical bills in the US are very high, but do they warrant this level of fear? On one hand, the lack of price transparency and standardized pricing makes it almost impossible for patients to get an accurate estimate of healthcare costs beforehand. There are thousands of stories on Facebook and Twitter about exorbitant medical bills. Yet, according to a recent study published in The New England Journal of Medicine, less than 4% of bankruptcies in the US are caused by unexpected medical bills. This is in stark contrast to the >50% number that is often quoted in the media and by politicians. So is the fear of medical bills rational?

Fear of Access to Healthcare

One fear that afflicts people around the world is access to healthcare. In many parts of the world, access to rudimentary medical care is difficult and dangerous. Patients sometimes have to walk miles through conflict zones to reach the nearest facility and when they arrive, there may not be medicine or skilled staff that can help. This same situation plays out in developed countries too, although minus the conflict zones. People in rural areas often do not have ready access to healthcare and thus they fear what will happen if the need arises.

There is another fear related to access to healthcare – albeit one that is unique to the immigrant population. Many new immigrants are afraid to seek medical help because they fear being deported back to their home countries. This is a fear for both illegal as well as legal immigrants…and it’s not just restricted to the United States. Immigrants in Europe, Australia and Canada all have the same fears.

To help address this fear, the people of British Columbia started a “Sanctuary City” initiative designed to create safe access to healthcare services to all people – regardless of immigration status.

Fear of Stigma

One fear that is shared by patients AND clinicians is the fear of being shunned and stigmatized if they admit to having mental health or addiction issues. As a result, many suffer in silence. In 2014 Patrick W. Corrigan of the Illinois Institute of Technology and his collaborators published a report about stigma as a barrier to mental health treatment.

The prejudice and discrimination of mental illness is as disabling as the illness itself.  It undermines people attaining their personal goals and dissuades them from pursuing effective treatments. The desire to avoid public stigma causes individuals to drop out of treatment or avoid it entirely for fear of being associated with negative stereotypes. Public stigma may also influence the beliefs and behaviors of those closest to individuals with mental illness, including friends, family, and care providers.

In 2018, the Center for Addiction and Mental Health (CAMH) in Toronto launched an online course aimed specifically at reducing the stigma of seeking help. Their goal is to help people around the world and to eliminate the fear of coming forward.

Using Fear to Motivate Behavior Change

Not all fear in healthcare is bad. Fear can help motivate people to take action on their health. Warnings about the health risks associated with high-sugar diets, sedentary lifestyles and smoking have all been effective at pushing people to make changes.

I have three close friends that have radically changed their lifestyles as a result of a healthcare scare. They had tried for years to make changes, but it wasn’t until they got an abnormal result or saw a loved one succumb to a preventable disease that they were finally inspired to take action.

Fear can be a powerful force for change.

Join me Tuesday October 30th at 8:30pm ET (for your local time click here) as we explore fear in healthcare. I’ll be wearing my Iron Man mask while tweeting.

  • T1 In your opinion what do patients and clinicians fear most about healthcare?
  • T2 What technology, education or process is most effective at reducing the anxiety and fear of in healthcare?
  • T3 Is healthcare marketing that uses fear to motivate behavior change effective on you? Share examples of effective campaigns.
  • T4 What fear, if eliminated, would help the healthcare system the most? Why?

Resources

Rau, Jordan. “Surprise Medical Bills Are What Americans Fear Most in Paying for Health Care”, Kaiser Health News, 8 September 2018, https://www.healthleadersmedia.com/finance/surprise-medical-bills-are-what-americans-fear-most-paying-health-care, accessed 28 October 2018

Kirzinger, Ashley et al. “Kaiser Health Tracking Poll – Late Summer 2018”, Henry J Kaiser Family Foundation, 5 September 2018, https://www.kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-late-summer-2018-the-election-pre-existing-conditions-and-surprises-on-medical-bills/, accessed 28 October 2018

Cramer, Maria and Cote, Jackson. “A horrific injury. A heroic rescue effort. And a desperate plea: Please don’t call the ambulance, it costs too much”, The Boston Globe, 2 July 2018, https://www.bostonglobe.com/metro/2018/07/02/woman-got-her-leg-caught-gap-orange-line-train-and-then-begged-for-ambulance-because-cost/q6gBPV8ujcfH0qLrQ6HjEJ/story.html, accessed 28 October 2018

Dobkin, Carlos et al. “Myth and Measurement – The Case of Medical Bankruptcies”, The New England Journal of Medicine, 22 March 2018, http://pnhp.org/blog/2018/03/22/the-myth-that-medical-bankruptcies-are-rare/, accessed 28 October 2018

Gillies, Trent. “Why health care costs are making consumers more afraid of medical bills than an actual illness”, CNBC, 22 April 2018, https://www.cnbc.com/2018/04/22/why-health-care-costs-are-making-consumers-more-afraid-of-medical-bills-than-an-actual-illness.html, accessed 28 October 2018

Elejalde-Ruiz, Alexia. “Fear, anxiety, apprehension: Immigrants fear doctor visits could leave them vulnerable to deportation”, Chicago Tribune, 22 February 2018, https://www.chicagotribune.com/business/ct-biz-immigration-fears-hurt-health-care-access-0225-story.html, accessed 28 October 2018

Fenton, Siobhan. “Pregnant immigrants are avoiding natal care because they’re afraid of being deported. How has the NHS come to this?”, The Independent, 21 March 2017, https://www.independent.co.uk/voices/pregnant-immigrants-refugees-payment-passport-checks-nhs-how-a7641156.html, accessed 28 October 2018

Britten, Liam. “Undocumented immigrants who fear being deported need health care says advocate”, CBC News, 5 May 2016, https://www.cbc.ca/news/canada/british-columbia/undocumented-immigrants-health-care-1.3567310, accessed 28 October 2018

Kenny, Ciara. “Illegal Irish workers in Australia face a perilous existence”, The Irish Times, https://www.irishtimes.com/life-and-style/abroad/generation-emigration/illegal-irish-workers-in-australia-face-a-perilous-existence-1.2771284, accessed 28 October 2018

Corrigan, Patrick. “Stigma as a Barrier to Mental Health Care”, Association for Psychological Science, 4 September 2014, https://www.psychologicalscience.org/news/releases/stigma-as-a-barrier-to-mental-health-care.html, accessed 28 October 2018

Parcesepe, Angela M and Leopoldo J Cabassa. “Public stigma of mental illness in the United States: a systematic literature review” Administration and Policy In Mental Health, September 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835659/, accessed 28 October 2018

Rankin, Lissa. “How To Reduce Fear & Anxiety About Disease & Death – Part 4”, Psychology Today, 26 March 2013, https://www.psychologytoday.com/intl/blog/owning-pink/201303/how-reduce-fear-anxiety-about-disease-death-part-4, accessed 28 October 2018

Image Credit

Trans-Allegheny Lunatic Asylum – Zack McCormick https://flic.kr/p/8xBamz

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