In Denial: Why Do We Often Ignore Medical Symptoms, When We Know Better?

Putting off a visit to the doctor, even to check what could be a sign of a serious illness, is surprisingly common, experts say.

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I didn’t need genetic testing to tell me I’d get cancer. Given my family history (three aunts with breast cancer, cousin Becky with thyroid, cousin Chris – who never smoked – with lung), I’ve long felt that it wasn’t so much a matter of “if,” but of “when.” Still, last year, when I noticed that a mole on my knee suddenly seemed darker than usual, my “matter-of-fact” attitude faded, and I went into denial mode.

“Whatever it is, it’s not serious,” I told myself. “It’s always looked that way.” And when I could no longer ignore the voice in my head – the one that knew better – I procrastinated for a few more weeks with the tried-and-true excuse of “I just don’t have time for this right now.”

As someone who writes about health for a living, I know just how quickly a person’s health status can change when they stubbornly refuse to seek help. Yet there I was, willfully ignoring a symptom that I would have told anyone else to get checked out, immediately. When I finally did see my family doctor for something unrelated, I tacked it on as a “By the way,” to the end of the appointment. Sure enough, it was melanoma.

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Ignoring symptoms of a disease with a high mortality rate is a surprisingly common phenomenon, says Dr. Kim Lavoie, co-director of the Montreal Behavioural Medicine Centre and a psychology professor at the University of Quebec at Montreal. “People will cognitively avoid things they don’t want to be real; it’s a natural defence mechanism,” she says. Studies have shown the different ways it manifests – from using humour, to outright refusal to acknowledge that an illness might exist.

“Many people delay seeing their doctors, and won’t even tell their spouses,” Dr. Lavoie says. And when they finally make an appointment, they tend to minimize their symptoms. “Patients will lead the discussion in a certain way, so that the doctor will be more likely to reassure them,” she says, which means that doctors often don’t get a true history and may make important decisions based on inaccurate information. Denying that something is amiss, Lavoie says, leads to delayed diagnosis and treatment, and poorer outcomes. So why do otherwise rational people take an “if I don’t see it, it isn’t there” approach to symptoms that can have a devastating effect on their health?

A study published in the British Journal of General Practice in 2015 found that almost half of cancer patients ignore early warning signs such as a persistent cough or an unexplained lump. “Our research found that people are very unlikely to consider cancer as a possible cause, even when they ‘know’ these symptoms can be cancer warning signs,” says Dr. Katriina Whitaker, a senior lecturer at the University of Surrey and lead author of the study. Dr. Whitaker says many people are afraid to even book an appointment because they’re worried about what a doctor might find. “We’ve discovered that people are reluctant to even mention the word ‘cancer’ in their responses to us, almost as though if you mention it, you’re doomed.”

When Dr. Whitaker asked people with potentially serious symptoms why they didn’t seek help, their reasons ranged from fear of the outcome, to not wanting to make a fuss. Both men and women said they were reluctant to waste their doctor’s time over something they’d decided was trivial, and many believed that they should just be strong and tough it out.

Others used busyness or competing priorities as reasons for not checking in with their doctors. “This was a key finding in our recent work looking at educational differences in responses to breast cancer symptoms,” Dr. Whitaker says. “While all women reported being “busy,” those with lower education were more likely to cite busyness as a reason for not seeking help.” This may be especially true for people who are self-employed without benefits, afraid to miss work, or worry that their job may be in jeopardy if it turns out they really are sick. (Past studies have shown that people who live in poorer communities are more likely to be diagnosed late, possibly because they’re more likely to ignore their symptoms due to concerns over loss of income.)

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Dr. Chris Simpson, chief of cardiology at Queen’s University and past-president of the Canadian Medical Association, says for those without these concerns, using busyness as a reason to put off getting help can be another form of denial. “People will say ‘I’ll deal with it once X or Y is done, then I’ll be in a better place to take some time to look after it.’ It’s a way of ordering things in your head that allows you to cope.”

He says younger generations have a particularly tough time coming to terms with the signs of a life-threatening illness. “They’ll deny the symptoms, then they’ll deny the diagnosis as they try to cope with it,” he says. “They’ll say things like, ‘I did everything right. I eat right, I exercise, I’m in good shape – how can I have this?’ It’s almost a grief reaction.”

Dr. Simpson has seen firsthand what happens when cardiac patients choose denial over visiting their doctors and says that, in hindsight, most acknowledge that they knew they were in trouble all along. “On some level they recognize, ‘Gee, this could be my heart, but maybe it’s something else.’ They rationalize it – ‘it’s nothing, it’s gone now, it was just a one-off.’” He has been at the bedsides of patients recovering from heart attacks who admit they had chest pain for weeks leading up to the event. “They often feel kind of sheepish about it because it was so textbook.”

In 2015, a study in the Annals of Internal Medicine found that only one in five people who have heart attack warning symptoms call for help. Dr. Simpson recalls a patient with heart failure who gained 50 pounds before she finally ventured into the hospital with huge, fluid-laden legs. “Her skin had actually started breaking down and was weeping fluid,” Dr. Simpson says. “When you see a patient like that, you think, ‘How could you possibly have thought this didn’t need to be dealt with?’ Denial is something we all do when we’re faced with something we’re afraid of, but sometimes the advanced state of denial – and the persistence of it – is striking.”

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Unfortunately, Dr. Lavoie says, tackling denial is tricky. “You can’t approach symptom deniers with logic.” This puts a burden on doctors who, she says, aren’t always equipped – they’re well trained to treat physical symptoms, less so to treat emotional ones.

“We need to teach physicians to recognize that patients are coming to them across the full continuum, from hypochondriac to denier. Anticipating this range of reaction increases the likelihood they’ll get a more truthful picture.”

Then, doctors must find a way to help patients acknowledge they may have a serious illness. “You start by normalizing the emotional response and getting patients to admit how anxious and afraid they are,” Dr. Lavoie says. “Only then can you clarify what they can realistically expect to happen.” Her main advice for patients is to see their doctor if they notice a change that isn’t normal for them. “People worry about wasting doctors’ time, but they’re there to help.”

When I finally admitted to myself that I had a mole that had changed, I was lucky – it was only stage one. Two biopsies later left me with little more than a Frankenstein scar along my knee – but also a cognitive shift. Doctors will check my skin every six months for the rest of my life, but I’ll be checking every week. If something changes, I know better than to wait.

Originally published January 2017; Updated November 2018.

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