Plenty of patients, especially women, experienced understandable anxiety at their MD’s office or hospital while the COVID-19 virus was surging, but the problem still exists beyond the context of a pandemic and it can have serious consequences.

Moore R, Purvis RS, Hallgren E, et al. “I am hesitant to visit the doctor unless absolutely necessary”: A qualitative study of delayed care, avoidance of care, and telehealth experiences during the COVID-19 pandemic. Medicine. 2022;101(32):e29439.

 

Women are afraid of seeing a doctor for a few key reasons, including “discomfort with physical examinations, fear of having a serious illness, and associating doctors with death.” Beyond this, research also shows that many patients exhibit needle phobia.

Taber JM, Leyva B, Persoskie A. Why do People Avoid Medical Care? A Qualitative Study Using National Data. Journal of General Internal Medicine. 2015;30(3):290–297.

Alsbrooks K, Hoerauf K. Prevalence, causes, impacts, and management of needle phobia: An international survey of a general adult population. PLoS One. 2022;17(11):e0276814

 

 

Physiological changes

 

Steph Fowler, LCPC, CADC, says that this fear can lead to several physiological changes and behaviors that ultimately break down the experience, leading to inaccurate test results (like false hypertension) or a poor relationship with the clinician.

Anxiety or Falm Can Cause False Blood Pressure Readings. UAB Medicine. July 5, 2023.

 

“Fear and anxiety could lead to increased blood pressure and heart rate or visible manifestations, such as sweating, fidgeting, or trembling,” Fowler says. “However, these can also show up in various other nervous system responses, like getting agitated, shutting down, or the mind going blank.”

Mary Poffenroth, MS, a biopsychologist who researches how the nervous system and brain shape mental processes and behavior, tells MDLinx that fear leads to dangerous avoidance behaviors. “When patients worry excessively about what a doctor may find or tell them at an appointment, their amygdala interprets the situation as dangerous even if rationally they know their fears are unlikely,” she says. This leads to canceled or postponed appointments and to potentially harmful delays in diagnosis. It can also erode the patient-doctor relationship, she says.

 

'Fawn behavior' in women explained

 

More so, this sort of physiological change can lead patients—especially women, Fowler adds—to exhibit “fawn” behavior, in which a patient is “overly agreeable and [does] not bring up all their concerns or express[es] discomfort to avoid being viewed as a ‘bad patient.’”

Fear most often occurs during gynecological exams, according to research published in the Journal of Primary Care & Community Health.

O’Laughlin DJ, Strelow B, Fellows N, et al. Addressing Anxiety and Fear during the Female Pelvic Examination. Journal of Primary Care & Community Health. 2021;12:2150132721992195.

Pelvic exams, specifically, “can provoke negative physical and emotional symptoms such as pain, discomfort, anxiety, fear, embarrassment, and irritability.

 

These negative symptoms can interfere with preventative health screening compliance resulting in delayed or avoided care and significant health consequences,” the authors write. 

 

How to best support a frightened patient

 

Key recommendations for supporting patients in this setting? Assessing patients for anxiety before the pelvic exam, starting conversations about pelvic examinations early on, and offering the presence of a chaperone or support person during the exam.

“During an examination providers should ensure the patient is comfortable, negative phrases are avoided, the correct speculum size is utilized and proper lubrication, draping, dressing and positioning are performed,” the authors recommend. “Treating underlying gynecologic or mental health conditions, consideration of cognitive behavioral therapy and complementary techniques such as lavender aromatherapy and music therapy should also be considered when appropriate,” they continue.