By Evan Falchuk

At the Well blog, Tara Parker Pope links to a provocative piece by Dr. Pauline Chen on what happens when a diagnosis is missed.

Dr. Chen writes about a patient that had found a small mass on her breast.  Ignoring her doctor’s advice to start the process of properly diagnosing and treating it, she decided to try alternative therapies.  It wasn’t until the tumor had become “the size of a young child’s head” that the patient became worried enough to visit Dr. Chen and have surgery to remove it.

In her piece, Dr. Chen wonders about issues in our care delivery system that lead people to miss out on getting the right care.  But I think cases like Dr. Chen’s patient are of an entirely different kind.  They’re suffering not just from the effects of disease, but also another, more common problem, denial.

I remember my father, who is an internist, telling me stories like the one Dr. Chen tells.  These were people with obvious, visible effects of a disease, but who weren’t getting any care.  It wasn’t that they had no one paying attention to them – often they had family and friends almost begging them to go and get help.  They just refused to go.

It is a reaction that I think is common to anyone who has suffered from a serious illness.  You don’t want the bad thing to be happening, it’s much easier to deny its existence.  The thinking is: I don’t want to be sick.  If I need medical treatment, then that means I’m sick.  So I will not seek medical treatment.

It’s much worse if the family of the patient is in on it, too, enabling the denial.  And I’m sure it’s devastating to those family members who want to see their loved one get help, but can’t get them to listen.

It seems like it’s very hard for doctors, too.

Dr. Chen is right to point to ways in which our system can do better at reminding people of the importance of following up on their doctor’s recommendations.  But the problem she is talking about is much deeper and fundamental to the human psyche than any change in the process of delivering care may be able to ever address.