Capsule Commentary on Taber et al., Why Do People Avoid Medical Care? A Qualitative Study Using National Data

Taber et al. identified four broad categories for why people avoid medical care. This commentary explores the dark side of one of them: unfavorable evaluations of seeking medical care, or “acceptability.”¹ As clinicians and researchers, we have explored a variety of mechanisms to increase acceptability: e.g., improving patient–provider communication, focusing on patient preferences, and incorporating shared decision making. We are finding ways to incentivize primary care providers so that they have the time to develop relationships with patients; and we are exploring ways to create more primary care providers so that all patients can have quality time with their provider. These ideas can all help reduce the unfavorable evaluations of providers and the healthcare system. However, these efforts at improving acceptability only target the patient–health system interface. This may not be sufficient since many individuals voiced distrust and dissatisfaction generally: “low confidence in medicine,” “don’t trust doctors,” and “doctors care more about money than patients.” And one person said that they avoid going to the doctor “to stay healthy.”

One reason for the general mistrust of medicine today is that people judge the acceptability of medicine based on their perceptions of the medical system, in addition to their face-to-face encounters. There are books², newspaper articles³, and academic journal articles^4,5 describing the inner machinations of the business of health, including: ghost writing medical articles; speaking fees to promote off-label uses for drugs; lavish, yet permissible, gifts to doctors for educational or consulting services; drug company involvement in continuing medical education; deceptive writing to obscure negative or null findings in journal articles; and financial ties of scientists and institute directors at the NIH to industry. Even medical professional organizations are obliged to keep their sponsors happy. These publications then get taken up by bloggers and are spread on social media. Knowledge of these practices tarnishes the entire medical community. So, in addition to facilitating patient communication and preferences, we should also explore ways to highlight and abolish these behind-the-scenes practices, not just to improve the image of medicine, but to honor the spirit of medicine and to safeguard patients’ health.