I HATE DOCTORS!

Iatrophobia or Iatromisia?

 

Jorge O. Galíndez, PhD*

 

Rubbing her trembling hands vigorously while seated on my office stretcher, Wende kept looking at me with a glare that was both, defensive and pleading.

After introducing themselves, her parents told me that, with much persuasion, she had agreed to consult a physician -but only on the condition that she chose him herself. My name come up because a college classmate told her that I was "calm," and that recommendation—acted like a magic spell, helping her decide to come in.

The reason for the visit was serious: significant weight loss and "large lymph nodes all over her neck" that had been worsening for months.

Watching how defensive she was, I approached slowly and said, "Relax, it’s okay, don´t worry is nothing; I’m just going to..."

¡I couldn't finish what I was began to say!

With her face contorted with distress, she leaped off the stretcher, ran to the door and flee  while shouting,

"I hate you! I hate you, and I hate all doctors!"

Her mother ran after her and, on the verge of tears, managed to say:

"Forgive us, Doctor. We don't know what to do with this girl anymore; she has a doctor´s phobia."

Jeff, her father, tried to remain calm but couldn't stop blaming himself: "We’ve noticed her health declining for months, but she wouldn't hear of visiting a doctor. When finally decided to come look at the mess she caused us."

I must admit, this was my first time I had ever faced a kind of dramatic situation.

Was I dealing with a patient suffering from Iatrophobia or Iatromisia?

From a psychiatric perspective, iatrophobia is an irrational fear of physicians, whereas iatromisia refers to an active, conscious rejection to them.

At that time I had only two clues: she said “I hate you”, but her mother described her behavior as “doctor´s phobia”.

I leaned towards the first mental disorder.

If I was right, then, I have  made a hugh mistake by telling her,

“Relax, it’s okay don´t worry is nothing”

I should have known that downplaying the extreme distress a phobic person endures triggers crises and produces the exact opposite of the intended effect.

That was undoubtedly what had happened!

The challenge was how to tackle this complex situation, which combined a likely serious clinical illness—dangerously relegated to the background with a mental health disorder.

There was no room for maneuver; both issues had to be addressed simultaneously.

Two famous examples that could help us avoid repeating past errors were Michael Jackson´s illness, who, despite his immense fortune, lived in paranoid seclusion, plagued by an unmanageable fear of illness and physicians and Marlon Brando´s personality, who made no secret of his hatred to doctors and conventional medicine.

In both instances, essential treatments that could have at least improved their quality of life were not indicated in time.**

Let’s return to Wende.

Time was running out; she refused to return to  the Hospital, so I consulted a renowned psychologist, and together, having obtained her consent, decided that we would conduct home healthcare visits.

The sessions took place in her bedroom, with the door open and without her parents, though she was always accompanied by “Dotty” her imposing pet.

Dotty never left her side and always greeted us cautiously, with a hostile look and constantly watching every one of ours moves as if nothing could fully convince her that we were truly “friends.”

As the days went by, Wende allowed us to set up a Home-based hospitalization that would allow us to move as quickly as possible toward a definitive diagnosis; she also accepted the presence of a therapeutic companion whenever she needed to be examined, undergo blood draws, and—most importantly—have a biopsy performed on one of her suspicious lymphadenopathies.

Progress was not easy; however, after several visits, we managed to establish a better connection—moving from a state of readiness to flee to moments where she smiled faintly. As the sessions progressed, she began to lower her defenses, and although her fears remained, she became more receptive.

Three months have passed since the first appointment; today she completed her third cycle of chemotherapy. Her voice is fragile, yet, overcoming her fears, she strives to convey faith and hope.

We both know that her general condition is poor and that, due to the advanced stage of her illness and the late start of treatment, the prognosis remains uncertain. But in the other side, we know that there is still a chance and that not all is lost.

Without saying it, we both are aware that we will soon by facing the final fight, side by side, calms,  full offaith  and hope.  !

The last time I visited, Dotty remained steadfast and unwavering by her, a true pillar of strength that seems to hold her to life but, of course, always on guard.

Even in the face of a grim prognosis, watching them always so close makes me fantasize and wish,  ¿why not, a happy ending? where both, Wende and Dotty defeats the psychophysical demons plaguing them, wich, in retreat, surrenders before such love, loyalty, and innocence.

Phobias should be treated earlier.

* Distinguished Physician of the city of Rosario, Argentina. Author of "Ya no es tan grave. La historia de los médicos que enfrentamos al Sida" (It’s Not So Serious Anymore: The Story of the Doctors Who Confronted AIDS) and "Mientras el mundo se transforma. Reflexiones sobre Medicina, Ciencia y Liderazgo" (As the World Transforms: Reflections on Medicine, Science, and Leadership). Holds a Master’s degree in AIDS from the University of Barcelona.

** From the extensive existing literature on this subject, I highlight and recommend "A Psychiatric Perspective on Iatrophobia" (The Journal of Medical Ethics by Nassir Ghaemi et al.), "The Fear of Doctors: A Qualitative Study of Patients' Experiences" ( Patient Education and Counseling by J. M. Taber et al.), and "Cultural Factors in Iatrophobia in a Latino Community" ( Psychiatric Services, by R. A. Davis).