It is not always easy for people to accept the realities of their medical needs, which can lead to denial in patients. When a patient is in denial, managing that patient grows more challenging for physicians.
As a result, according to medical writer Dr. Naveed Saleh, MD, MS, patients in denial may experience poor medical care outcomes. Whereas inpatient settings often offer the opportunity for physicians to consult with psychiatric professionals when dealing with patients whose denial is adversely affecting their care, doctors in an outpatient setting must rely on patients to help responsibly manage that care. Unfortunately, outpatients who are in denial may end up compromising their medical state by missing appointments or not taking medications.
Denial is not all bad. For example, it can help patients to stay positive when first learning of their medical situation. According to an International Journal of Psychology and Psychoanalysis case-control study of patients with digestive-system cancers, denial can actually protect patients from depression. However, although denial may initially help patients adapt to bad news regarding their medical state, it may ultimately hinder their ability to make appropriate healthcare decisions.
Anosognosia: Extreme, Unconscious Denial in Patients
Based on a StatPearls article, some patients suffer from extreme, unconscious denial, known as anosognosia. While anosognosia can be either a neurological or a psychiatric disorder, it most frequently takes hold due to structural damage from events like ischemic stroke. Dr. Saleh stresses that such situations can prove dangerous for patients who, for instance, may not recall pertinent information like the timing of the stroke. Authors of the StatPearls article emphasize that when a physician has a patient suffering from anosognosia, it is crucial that the physician take measures like simplifying tasks, demonstrating empathy, and fostering a structured environment. Doing so can help the patient avoid injury and other negative outcomes.
While some patients in denial may fully refuse to accept their medical condition, others may acknowledge their diagnosis but refuse to accept the need for treatment. According to a JAMA Psychiatry article, a blending of cognitive and psychosocial techniques like motivational interviewing and shared decision-making would likely be warranted for such situations. The authors of the article suggest that these approaches can aid in increasing a patient’s willingness to adhere to vital treatment and management protocols, allowing them to take more ownership of their situation. Such reflective and adaptive strategies provide patients with the opportunity to make more informed and self-guided decisions.
Above all, it is crucial that physicians not place judgment on patients suffering from denial. Dr. Sachin H. Jain, MD, MBA wrote a Forbes article discussing how denial can sometimes occur as a means for coping with the news of a grave diagnosis. Dr. Jain urges healthcare professionals to approach such patients with curiosity, seeking to understand their denial’s root cause and then, with sensitivity, helping patients to acknowledge that root cause. There is no place for judgment when dealing with the complex feelings and emotions of patients facing a difficult diagnosis.