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Making the Exam Room a Judgment-Free Zone

“How many alcoholic drinks do you have each week?”
“Do you have unprotected sex?”
“Do you use recreational drugs?”

If someone in your everyday life asked you such direct questions, you might be taken aback. But inside the doctor’s office, patients routinely disclose personal information that even their closest friends wouldn’t know.

We rely on doctors to help us stay healthy and guide our medical decisions. But it can’t be a one-sided relationship; to get the most out of healthcare interactions, we need to give doctors full and unsparing accounts of our health habits. 

Many of us worry about about being judged when we put on the paper gown. What makes us fret over how doctors see us? And how can doctors and patients prevent anxiety over judginess from undermining healthcare? As a social psychologist, these are some of the questions I’m most interested in. From both my own investigations and others’ research, I’ve seen how fear of judgment can shape everything from what we tell doctors to whether we approach them in the first place.

Doctors and other healthcare workers have similar health habits to the average person.

It might be tempting to fudge the truth when we open up about health habits, especially the ones we ought to improve. Research suggests that in some cases, patients do: In interviews, heavy drinkers minimize how much they drink each week. People who are overweight or obese underreport how much food they eat, sometimes selectively hiding how much fat their diet contains. An intriguing experiment hooked up undergraduate students to a fake lie detector to see how it would influence the number of past sexual partners they reported. Men tended to overreport how many sexual partners they had, adding on average one extra person to their tallies, whereas women tended to drop one from the list.  

All of this shows how we tweak health disclosures to line up with societal expectations or match the behavior we assume is socially desirable. We do this despite knowing that our doctors have probably seen patients with a wide range of lifestyles and health profiles. So why should we be afraid to paint an honest picture of our health? Here’s one possible explanation, supported by my research: We assume that doctors are paragons of health, just by virtue of their profession. If we confess to shoddy gym attendance or frequent drive-thru trips, it stands to reason, we’ll invite their scorn.

But that assumption doesn’t bear out. Doctors and other healthcare workers, according to some research, have similar health habits to the average person. They don’t eat better or exercise more, and are just as likely to be overweight as other Americans. On some measures, doctors actually perform worse than average. While about 26 percent of Americans eat the recommended five daily servings of fruit and vegetables, for instance, research indicates that only 15 percent of doctors can say the same.

This makes sense, given that healthy lifestyles take time to maintain. With their demanding schedules, doctors might be less likely than others to max out their class-pass membership or set aside an afternoon every week for meal prep.   

The next time we’re tempted to tell a half-truth in the doctor’s office, we should remind ourselves that doctors are people too. They might have their own health battles to fight, and they might be more inclined to sympathize with patients than scoff at their struggles.

Still, some doctors do have more laudable health habits than their patients. For example, doctors are only half as likely to smoke cigarettes. And as with any group of people, there are doctors who love healthy cooking, start their days with sunrise yoga and run marathons. But our fear is often projection: In my work, I’ve found that patients tend to assume they’ll encounter judgment and disapproval from doctors who project a super-fit image, especially when those patients aren’t in perfect health.

In one of my studies, participants browsed real profiles of doctors sampled from Kaiser Permanente’s online doctor search portal. Some of these doctors provided details about their health habits, such as “To keep myself fit, I like to hike, bike and exercise,” “With my spouse, I enjoy healthy vegetarian cooking” or (my favorite example) “I enjoy doing anything outdoors or even remotely athletic. Currently I play soccer, mountain bike, road cycle, ski and surf on a regular basis.” Advertising one’s own fitness like this might be well-intentioned — a way to show patients that a doctor can “walk the walk.” But we found that patients who struggled with their weight worried these doctors would look down on them and, as a consequence, wanted to avoid seeing them for care.

Can doctors share their healthy hobbies without inadvertently turning off patients who fear being judged? My research suggests they can. In one study, we took the same profiles of fit doctors and added a short sentence or two indicating that these doctors wouldn’t judge patients with different lifestyles or health priorities. These additions included notes such as “Everyone has their own definition of a healthy life and what it means to be healthy for them” and “It’s important to me that I help my patients to meet their own personal health goals.” The profile modifications changed patients’ perceptions of the fit doctors; overweight participants no longer shied away from them.

To help patients shed anxiety about being judged, doctors can communicate that they won’t judge patients on their health and emphasize that their central aim is to help patients meet the health goals that are important to them personally. These simple strategies make fit doctors seem just as approachable as those who don’t practice what they preach.  

Of course, doctors shouldn’t turn all visits into feel-good experiences or ignore unpleasant truths just to avoid hurting patients’ feelings. Doling out unwanted advice is part of the job. But rather than seeming to impose arbitrary standards on patients, doctors could illustrate how these suggestions will help patients meet their own goals. Importantly, research (and plenty of anecdotal evidence) also suggests that shaming patients isn’t motivational or helpful. In one study, obese patients who felt judged by their doctor shed fewer pounds in weight loss attempts.

There may also be ways for patients to take these matters into their own hands. Patients could start a conversation with their providers about their main health goals: What do you really care about when it comes to your health? Do you want to lose weight, or do you feel happy and energetic where you are? If you clarify your goals from the get-go, it will be easier for you and your doctor to manage your health together.

Regardless of whether we’re self-proclaimed french-fry enthusiasts or training for our next Ironman, most of us care about our health. Making the doctor’s office a judgment-free zone might be the best way to help us get there.  

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The Paper Gown, powered by Zocdoc, covers health and healthcare with a focus on patient experiences — inside and outside the exam room, before check-ups and after surgery, across all states of health. We strive to tell stories that help patients feel informed, empowered and understood.