Barriers to Obtaining a Good History of Psychological Factors

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Patients often do not volunteer the most important aspects of their story, especially at first, because of a number of factors including:

  • Mistrust of the health care professional

This can often be overcome easily by offering a genuinely sympathetic ear and a display of genuine interest and curiosity. Many patients have very personal stories of abuse and it is understandable that they would be wary to share this with a stranger. Experience shows that when the trust barrier is overcome, patients often have a strong need and desire to unburden themselves.

  • Embarrassment
  • Reluctance to look back on emotionally painful past experiences,
  • Concern by the patient that a certain line of questioning may interfere with their insurance claim.

Some patients are wary that notes taken by the doctor could be used against them by their insurance company.

  • An anti-psychological attitude by the patient

An example is the patient is over-quick to accuse their health care worker of saying the pain is all in their head, while at the same time shunning any possible psychological explanation that could result in them having to take responsibility for psychological failings that contributed to their illness.

  • An a-psychological attitude by the patient or clinician

When this attitude is present the person is not opposed to psychological insights but their approach to the world is more mechanistic or disinterested in psychology. As a result they may fail to generate psychologically based insights,

  • Laziness

Digging into one’s psychological past and trying to make sense of it can be hard work for the patient and the health care professional. Not everyone is willing.

  • Fibrofog

This clouds the patient’s memory of important details about their past.

  • Impatience by the patient to get an immediate solution for their suffering

Some patients have unrealistic expectations that the doctor must provide them with an immediate solution. This can set the bar higher than any doctor can attain and can lead to disappointment and failure in treatment efforts. In many cases it should be possible to manage these expectations by showing that the situation is complex and requires a patient thoughtful approach.