Fear and anxiety can be impediments to medical care; taking action may help


People who avoid medical care because of anxiety can receive help. (ISTOCKPHOTO)
June 10, 2013

A 59-year-old piano teacher with a well-controlled seizure disorder had been a patient of Orly Avitzur, medical adviser to Consumer Reports, for 13 years before the doctor stumbled upon the woman’s secret. She discovered it only because she asked the patient when she’d had her last colonoscopy.

The subject was out of Avitzur’s scope as her neurologist, but she was glad she broached it. The patient reluctantly told her that she had a debilitating fear of colon cancer. Her mother had died of the condition in middle age, and she was so afraid it would happen to her that she had avoided seeing her internist for a decade and had put off visiting her gynecologist for even longer. She was an intelligent woman, but she was letting fear get in the way of her health.

The woman’s reaction is not unusual. Colon cancer is the second-leading cause of cancer death in the United States, and 90 percent of cases can be detected (and often nipped away) through screening. Yet 38 percent of adults age 50 and older have never had a colonoscopy or sigmoidoscopy, and 79 percent have never had a fecal occult blood test. Fears, anxieties and other psychosocial factors are often barriers to screening, according to a 2012 study in the American Journal of Health Promotion. Fear also has been found to delay diagnosis of other cancers, including lung cancer, and to contribute to delays in seeking emergency care for heart attacks and strokes.

If fear is preventing you from getting the care you deserve, here are four tips that might help.

Admit that you are afraid. The first step in facing your fear is to identify it. Are you avoiding a recommended test because you’re afraid of what it may reveal? Or because the procedure itself is intimidating?

Nearly 40 percent of people in a 2012 United Kingdom survey about attitudes toward cancer admitted that they might delay getting their symptoms checked because of fears of what the doctor might find. Fear of hospitals has also been commonly associated with postponing medical care. And a fear of needles — which may affect about 20 percent of us — has been suspected of playing a significant part in people’s failure to obtain recommended tests, dental care and vaccinations. Homing in on your fear is often the first step in conquering it.

Don’t keep it to yourself. Share your fears with your doctors. They can help. Avitzur says that patients are at times referred to her for a type of nerve and muscle testing that involves electric shocks and needles. Many are anxious about the tests, which can be somewhat uncomfortable. So she goes over the testing procedure in advance, sometimes even demonstrating the electric shocks on herself. Doctors can lessen your apprehension by letting you know what to expect through diagrams, photographs or videos. For uncomfortable procedures, a sedative or painkiller can be prescribed.

Try therapy. Cognitive behavioral therapy — a type of treatment that is designed to help people replace negative thoughts, behaviors and emotional responses with more positive ones — has been found to help with anxiety, among other disorders. Sessions are often short-term and focus on working to resolve present-day problems. CBT can help you develop a more adaptive response to a fear. To find a specialist in your area, contact the National Association of Cognitive-Behavioral Therapists at www.
nacbt.org
.

Bring your spouse or a friend. If you think you’d feel better bringing someone along, ask your doctor if that would be permissible. Someone to hold your hand or chat with you might distract you from a scary test or procedure. One of Avitzur’s particularly anxious patients recently brought a friend to sit with her through nerve testing. They chatted as if the doctor wasn’t there, which was fine with her.

If having someone in the room isn’t possible (during an invasive test, for example), sometimes simply knowing that the person is in the waiting room can be a source of comfort. That’s what the piano teacher decided to do. When her husband scheduled his colonoscopy, she booked hers for the same morning. His support before and after the procedure helped get her through. And her worst fear never materialized.

Copyright 2013. Consumers Union of United States Inc.

For further guidance, go to www.ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.

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