Denial is the most basic human defense mechanism. Even when presented with clear evidence, some people can struggle to accept the truth. Often a patient’s denial of their medical realities involves other family members too. But denialism can impact the physician’s practice of medicine by reducing the treatment options available to provide preventive or post-diagnostic care.
Although medical denialism is not categorized as a mental disorder, there is growing concern in the healthcare industry that med students need to develop skills for recognizing and treating science-related denialism. This includes new guidelines with the objective of improving the quality of patient care through a better understanding for dealing with patient bias.
“Denialism in the practice of medicine is nothing new,” says Hans Wolf, M.D. and founder of the Physicians Achievement Concept Course. “Self-deception is one of simplest human defenses and a patient in denial is simply good at convincing themselves of a false truth. But it can be crucial to help that patient reframe their thoughts by helping them accept the science-based evidence presented.”
Denial is a convenient coping behavior that we all possess but that we may or may not be aware of. It is a technique for self-deception that allows a patient to create a mental barrier to protect their psyche from cognitive dissonance. Although self-denialism can provide temporary relief from the emotional discomfort of a medical truth, it can also exacerbate a difficult situation and lead to more challenging outcomes.
Moving from denial to acceptance…
In cases involving medical denial, it often involves either not acknowledging a reality or denying the consequences of a reality. Patients that exhibit denial may be struggling to accept a diagnosis that seems overwhelming. However, denialism works by pushing a problem to the back of the denialist’s mind. So, their reality follows the principle of “out of sight” and “out of mind.” As an exercise in mental gymnastics, it allows the denialist to confuse right-and-wrong with good-and-bad in their mind’s emotional axis.
Pseudoscience & Medical Denialism
Sigmund Freud coined the term “denial” in the early 1920s to define a defense mechanism seen in psychoanalysis where a person involuntary rejected an unpleasant reality. However, there is credible evidence that acts of both individual and group denialism actually date back to before the Ancients. Discussed below are some of common influences, such as:
- Religion & Culture – Some 2,000 years ago, Hippocrates challenged the long-held belief that the Greek gods were responsible for all disease. The Greek physician helped to define the medical process of diagnosis and treatment. But the neglect of cultural variances in medical studies has inadvertently fueled pseudoscientific notions that permeate diverse cultural belief systems. It is imperative for today’s medical community to prioritize understanding and respecting cultural beliefs. Only by recognizing a spectrum of perspectives can we improve patient trust in scientific evidence.
- Corporate Greed – Healthcare and pharmaceutical companies have become battlegrounds for public trust, not only because of the significant strides in progress they represent, but because of the shadow of greed that looms large over these sectors. It’s a stark reality that businesses at times are driven more by profit than by the welfare of humanity. They have inadvertently made choices that have fueled skepticism towards science. This manifests in the form of dangerous pharmaceutical denialism that casts unjust doubts on the intentions behind true scientific advancements.
- Self Interest & Trauma – In some instances, the use of denial can assist individuals in navigating the complex phases of illness and treatment. For some, the approach of temporarily disregarding the reality of their condition can provide a much-needed reprieve from the emotional distress of facing the full gravity of their situation. When working with terminally ill patients, doctors must recognize denial as a challenging coping mechanism and that the patient’s capacity for decision-making may be compromised.
- Opposition to Vaccines – Although the term “anti-vaxxer” is a recent addition to the Oxford Dictionary, public resistance to vaccination dates back to the late 1700s with the introduction of the smallpox vaccine. More recently, anti-vaxxers have focused on the long-term effects of childhood vaccinations for diseases like diphtheria, tetanus and pertussis (DTP) and measles, mumps and rubella (MMR). Anti-vaccine movements used the COVID-19 pandemic as fuel for making new claims against science-based evidence regarding both COVID and other proven vaccinations.
Since denial is an automatic reaction, it can trigger avoidance tactics to prevent acknowledgment that a certain problem exists. Even though there can be good reasons for a person to unconsciously deny a medical fact, there are usually more science-based reasons for them to let go of their denialism. It is a simple irrational action that allows them to refuse to accept an empirically verifiable truth.
Denied Facts Are Still Facts
People are questioning not just the integrity of pharmaceutical companies but the very essence of scientific endeavor and healthcare provisions. Inaccuracies and contradictions are now impacting global health through instances like HIV/AIDS denialism and a new wave of opposition to well-studied vaccinations. Such perspectives fuel mistrust toward authorities, including claims that pharmaceutical companies profit at the expense of the public.
“As anyone with internet access can search for data on nearly any subject, it has become increasingly difficult for some people to distinguish authentic information from misinformation,” explains Dr. Wolf. “The challenge for today’s medical students will be to bridge the gap between progress and perception by educating the patient and helping them to feel in control of their health and well-being.“
Amidst these challenges lies an urgent need for a revamp in the industry’s communication strategies. The healthcare industry, along with its scientific partners, must confront this erosion of trust head-on. Unfortunately, denialism is particularly prevalent among patients with certain mental health issues and studies indicate that using denial as an emotional defensive strategy correlates with adverse outcomes in one’s physical and mental well-being.
Clinical Implications of Illness Denial
Being in denial can lead to questioning one’s own judgments and experiences, effectively allowing oneself to be manipulated by other’s viewpoints, thus eroding personal conviction and independent thought. Individuals caught in the web of denial might shy away from seeking necessary medical care or ignore the need to address mental health concerns that profoundly affect their daily lives.
- PATIENT DELAY – Illness denial may lead to a delay in seeking treatment, impaired adherence to medications and reduced self-management that can lead to adverse outcomes. Whenever a doctor has to make sense of obstructive patient behavior, they should consider denial to be a “disease-like object” that needs to be diagnosed and treated.
- REDUCED COMPLIANCE – Pseudoscience has fueled denialism and distrust of having a foreign agent (vaccines) injected into the body despite scientists and medical scholars having described vaccination as one of the Top Ten achievements of 20th-century public health. Nonetheless, counterphobic behavior has continued to follow vaccines since their inception.
Consequently, the deeper a patient falls into denial, the more difficult it becomes for them to escape. This often leads to an immediate negative effect, such as feeling alienated, anxious, and despondent. Overcoming denialism requires acknowledging the roots of patient mistrust and committing to aiding fundamental change. Healthcare professionals must be ready to engage in more transparent, open dialogues with the public to demystify the processes behind drug development and agency approval.
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Although medical denialism is nothing new, it does define the need for today’s medical students to develop techniques for dealing with a patient’s reliance on innate defense mechanisms. After all, denying difficult emotions does not make them go away. If you’re ready to be the best physician you can be, contact us today to learn more about “The Power 5” approach and schedule your USMLE or COMLEX review program.
