As you may know, I see many patients each week as I practice dermatology. After asking questions about the problem and examining the patient, I make a diagnosis and suggest the appropriate treatment. I also attempt to do my best to understand how my patients feel about their illness and gain insight into what my patients are thinking.
This past week, a 40-something-year-old, attractive, intelligent, formally educated black woman visited me for a follow-up appointment. She had a scalp condition for which, one month earlier, I prescribed a medication that necessitated her wetting her hair prior to its application.
When she returned to my office, my patient had a cold. I heard sniffles and a stuffy nose from her upper respiratory infection, as she spoke.
She then steadfastly proclaimed that her cold was because she had gone outside with wet hair. I simply stated that colds are caused by viral infections and wet hair does not make a person more likely to develop a virus and catch a cold. I cited studies. I tried to reason and cajole.
Much to my amazement, my patient then told me that she had heard the information that I presented to her before, but that there was nothing that could say to ever make her think differently. Period.
Over the ensuing week, I turned to my sister, psychologist Dr. Flora Taylor, to help me understand and most importantly, help this patient.
My sister felt that the real question was -- what is the patient's investment in maintaining the belief that wet hair can lead to a cold, in spite of an appreciation for a more scientific explanation? The patient was clearly gaining something by what she was doing, or she wouldn't do it.
So what could this patient possibly gain by believing that wet hair can lead to a cold? Dr. Flora Taylor thought that the possibilities include:
- Maybe it makes her feel more comfortable to stick with her current beliefs. Familiarity is so comforting to people. People choose familiarity over many other -- what appear to be -- better choices.
- Maybe it's too threatening to think her mom or grandmom was wrong about something that is a common belief in some communities. Maybe this would lead her to have to confront her mother about the issue and that is not something she is willing to do.
- Maybe she is stuck in the belief because, like with any superstition, it has been reinforced (coincidentally) many, many times, and so she's going with the odds.
- Maybe she simply lacks any significant motivation to change.
- Familial and cultural beliefs are so powerful!!! We cling to them as we cling to parts of our identity. Sometimes we even feel gratified by the 'folksiness' of a belief.
My sister suggested that one way perhaps to approach the patient would be to meet her halfway. She said, "If you can find a way to join her, even a little bit, in her beliefs, she is more likely to hear you and therefore to comply with the medical regime. You could also do this by joking with her about some old-fashioned belief that you (we) grew up with that still amuses you and that you still remember -- like salt over the left shoulder when you spill it? But then differentiate that entertaining train-of-thought from what is important for her health." She then added, "Worst case, have her wear a hat over the wet hair?"
I must admit that I am amazed by my patient because she is otherwise intelligent, modern and educated, but she still has old-fashioned beliefs that apparently run pretty deep! My sister and I concluded that the bottom line for me, her physician, is whether she will comply with the regimen; so if she will, then problem solved.
If she won't comply, and her mind can't be changed then, there must be another solution: another medication, a timing change such that the hair is dry before she leaves the house, etc.
My sister, the psychologist concluded, "Flexibility in the medical profession, when it is absent in the patient, is the order of the day, doc!"
I'll try to do my best.
Follow Dr. Susan Taylor on Twitter: www.twitter.com/SusanTaylorMD