It’s too easy to blame people for the bad things that happen to them these days. Sadly, victim blaming almost feels like the new norm. From sexual assault (“what was she wearing?”/”why did she take so long to speak up?”) to domestic violence (“why didn’t they leave their partner sooner?”) to bullying (“why didn’t they talk to someone before it got out of control?”), adding blame only victimizes the victim further. Where’s the compassion?

Patient Blaming

Victim blaming has snuck its way into health care too and not only because doctors care for people who suffer from emotional and physical abuse. It comes in the form of patient shaming.

A patient will tell their doctor things about their body they may never tell another soul. They expose their bodies and their deepest thoughts. That relationship should not only be based on trust but on respect and caring. After all, doctors take an oath to “do no harm”. They should use their medical expertise to guide people to their best health, but they must do so with compassion and empathy. Instead, some doctors blame their patients for not doing “the right thing”.

Paternalism in Medicine

Fifty years ago, it would have been unheard of for a patient to question their doctor’s advice. Over the years, that paternalism has shifted to patient autonomy. Instead of the doctor dictating how things ought to be done, the patient has a voice in the decision-making process.

The problem? Time. With doctors forced to jam so many patients into a busy schedule, they have less time to spend with their patients these days. That limits how long they can walk through the issues, discuss treatment options, and LISTEN TO THE PATIENT. The patients’ voices, their personal histories, their unique health experiences are put aside while the doctor clings to a single symptom that fits into a convenient treatment algorithm.

Sadly, the pendulum is shifting from autonomy back to a paternalistic type of care. It’s simply easier for a doctor to tell people what to do and move on to the patient in the next room. It is no wonder more people report patient shaming. They feel their bodies are little more than a commodity to the doctor. They are depersonalized, dictated to, and stripped of their voice — yet again.

Behind Exam Room Doors

Look back to your last doctor’s visit. Did they listen to your concerns? Did they dismiss them? How long did it take before they interrupted you? Did they make eye contact or type constantly into their computer? Was their hand on the doorknob while you were still talking? Did they make you feel you had done something wrong?

Whether or not they intend it, many doctors shame people for having medical conditions they consider preventable. High blood pressure, high cholesterol, diabetes, heart disease. They blame them for what they eat, for what they drink, for how much they exercise, for not taking their medications as prescribed.

A doctor I know once complained to me that his Latino patients were obese because they ate too much rice. “If they would cut rice out of the diet and replace it with something else, they could lose the weight. It’s so easy, but they don’t listen.” I cringed at the cultural insensitivity. If I were his patient, I would feel disrespected and judged for my ethnic origins. There are more constructive ways to address the issue, ways to reach out and connect with each person to help them reach their goal. I told him so.

Responding to questions with black and white answers backfires in a world of color and diversity. In fact, force feeding “my way is the right way” can be outright demoralizing. Patients likely hold back if they feel they are being harshly judged and their own concerns are not being heard.

Why Doctors Need to Change Their Tune

A patient does not have to do what the doctor says, i.e., agree to take a medication, and a doctor does not have to do what the patient says, i.e., prescribe a medication they don’t feel is necessary. There needs to be a discussion between the two, an open discourse, to get at the heart of the problem and to make a plan agreeable to everyone. That requires listening to each other.

A doctor cannot simply say to his patient, “Lose weight”, and expect everything to fall in line. Losing weight is hard. What works for one person is not going to work for another. To demand it without offering specific dietary or fitness advice can be anxiety-provoking for the patient. The patient is shamed when he doesn’t succeed.

Instead of judging, doctors need to listen to the full story, to see how they can best work hand in hand with the patient. Maybe the patient tried different diets but still could not lose weight. The patient cannot go for walks because of severe knee pain. The patient got fired and could not afford his medication that month.

When the patient feels judged for their choices, when the patient is blamed for their health condition, when the patient’s personal experience is disregarded, he can feel victimized. The patient blaming has got to stop. The only way to get (and stay) healthy is to work together.