Why not knowing feels safer
If you've been putting something off for six months, you're in large company, and you're not being stupid. This chapter sets out why people do it, as fairly as I can, because the reasons are real.
Researchers have asked people directly. Jennifer Taber, Bryan Leyva and Alexander Persoskie analysed answers from 1,369 Americans in a national survey who were asked why they avoid medical care, even when they suspect they should go. More than half gave practical barriers like cost and time. In the American system cost is a large part of it. A third gave reasons the researchers grouped as unfavourable evaluations of seeking care. These included not liking or trusting doctors, bad past experiences, and what the researchers call affective concerns, which means fear, embarrassment and dread. And about one in eight said they didn't think they needed to go, often because they expected the problem to get better without treatment.
On the particular case of worrying symptoms, the fullest picture comes from a review by Lucy Smith, Catherine Pope and Johannes Botha. They brought together 32 studies from several countries, covering more than 775 patients and carers and at least twenty types of cancer. All of them asked people about the time between noticing something and seeing a doctor. The stories were strikingly alike across different cancers and countries. Two things kept appearing. One was the difficulty of recognising a symptom as serious. People explained things away as age, a pulled muscle, or something they'd eaten. The other was fear of the consultation itself, and that fear took two forms. There was fear of embarrassment, either because the symptom seemed too trivial to bother a doctor with, or because it involved a private part of the body. And there was fear of cancer, meaning fear of pain, suffering and death.
From those studies and from ordinary experience, I'd list four reasons behind the putting off.
The first is fear of bad news. It's the deepest one and the least often said aloud. While nobody has looked at the mole, it's a mole. Once somebody looks, it might become something with a name. The appointment feels like the moment at which the bad thing could begin.
The second is fear of being a nuisance. The surgery is stretched, and everyone knows it. You picture the doctor's face as you roll up your sleeve to show a mole you've had for thirty years. You'd be taking an appointment from someone who's properly ill.
The third is fear of the procedure. This might be the dentist's drill, the smear test or the needle. It might be the examination of a part of you that you'd prefer nobody examined. None of that is pleasant, and for some people it's much worse than unpleasant.
The fourth is hassle. There's the phone queue at eight in the morning, the form on the website, the time off work, and finding a dentist who's taking patients at all. The obstacles are real, and chapter 11 doesn't pretend otherwise.
Under these lie needs that nobody should be ashamed of. You want to be well, and you'd rather not be frightened. You also want to be treated with respect, and you don't want to waste anyone's time, your own included.
The question for the rest of the book is whether putting it off serves any of those needs. I'll take the four reasons in turn. I should say now where I'm heading, since this series doesn't keep secrets from the reader. In my view the putting off doesn't serve any of those needs. It gives you a small relief that lasts a week or so, and you pay for it with months of low dread and, now and then, with something far worse.