White Coat, Black Art

Breast cancer meant confronting her worst fear: seeing a doctor

Iatrophobia, an extreme fears of doctors, can cause some people to delay seeking care. This can have devastating consequences.

A condition called iatrophobia, an extreme fear of doctors, can cause some to delay seeking care

Barbara Old's brush with a life-threatening disease forced her to overcome her paralyzing fear of doctors. She's seen here in the wood shed on her Vancouver Island property. (Submitted by Barbara Old)

Originally published on Nov. 20, 2021

Barbara Old once went 30 years without going to a doctor.

"It kind of evolved slowly. I can't really understand or put my finger on how I came to that," Old, a retired director of international education at the College of New Caledonia, who now lives on Vancouver Island, told White Coat, Black Art host Dr. Brian Goldman.

"Fortunately, I never really got sick … but it just kind of evolved into an extreme phobia."

The 62-year-old has a condition called iatrophobia, which is a fear of doctors. In the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), it and other phobias are considered types of anxiety disorders marked by "excessive or unreasonable" fear that interferes significantly with normal functioning.

For Old, that fear caused her to suffer panic attacks on two separate occasions when sitting next to a physician on an airplane. She once neglected a broken ankle for three days, dismissing it as a bad sprain, until a physiotherapist said she needed the fracture set at her local hospital.

About one in 10 Canadians have a specific phobia of some kind, according to the Canadian Psychological Association, but the most common types are fears of animals and of heights. Due to limited research on the condition, it's difficult to say for sure how many people suffer specifically from iatrophobia, but one 2019 research study said it's "common among patients and can negatively impact their health-seeking behaviours."

Whether full-blown phobia or not such fears are concerning in the middle of a global pandemic, when controlling the spread of a deadly virus hinges on the vast majority of people trusting the medical establishment, said Dr. Gary Rodin, a psychiatrist at the Princess Margaret Cancer Centre in Toronto. 

He said iatrophobia is on a continuum of health-related anxiety that has been amplified by the pandemic.

"Anxiety about health, misinformation about the vaccine and the sense of losing personal control have likely contributed to vaccine hesitancy and refusal in some individuals."

It's essential to address this issue by building a trusted relationship between individuals and their health care provider and through clear, consistent and credible messages from public health officials, he said.

Tragic outcomes

Psychiatrist Gary Rodin said patients usually respond well to treatment for iatrophobia, or fear of doctors, but the biggest challenges stem from delayed diagnosis and treatment as a result of avoiding care. (PhotoGraphics@UHN)

Another challenge is when diagnosis and treatment of an illness are delayed because the patient has avoided care, said Rodin.

"It is tragic when people delay treatment for a long period of time, so that actually, their outcomes may be worse than they might otherwise have been," Rodin said. 

Iatrophobia can be broken down into three specific fears, according to the 2019 study:

  • Fear of illness itself and the medical exam.
  • Fear of the doctor's reaction (for example, if the patient reveals an unhealthy or embarrassing behaviour).
  • Fear related to the systemic barriers to getting care (such as racism). 

When Old discovered a lump in her breast in 2015, she was scared, like anyone might be, but not just of a potential diagnosis — rather, of having to see a doctor. She knew she could no longer avoid seeking medical care.

"You know, you get that sort of complete fear, prickling feeling that goes up your spine, and your stomach sinks and you just kind of want to fall to the floor, faint or vomit or something? That's how I felt."

Therapy and medication can help

"I think the fear of doctors and the fear of health care and health-care facilities is actually very common, perhaps even universal," Rodin said.

He notes that there's a phenomenon called "white-coat hypertension," which is anxiety related just to being in the presence of a doctor and having blood pressure measured.

Patients with iatrophobia can experience severe distress and panic attacks that prevent them from seeking care or make administering essential treatment, such as chemotherapy, extremely difficult.

Rodin said patients tend to respond well to treatment for iatrophobia. Cognitive behavioural therapy helps, as does establishing a trusting relationship with a medical caregiver. Medications, including those that help control anxiety, can also be part of a treatment plan, he said. 

More than just scared

Eventually, after returning from a trip, Old told her good friend, Cathe Wishart, about the lump in her breast. Wishart told Old she needed to see a doctor. And, until that moment, Wishart hadn't realized just how severe Old's fear really was.

"That morning, she was just in no space to take any direct action on her own. She started sort of freezing up," Wishart said.

"I went to get her at the time of the appointment, because she was really clear that she could not walk down there by herself."

Cathe Wishart, Old's friend and former colleague, pictured outside a building on the college campus where she works, helped her seek care for a lump in her breast despite Old's extreme phobia of doctors. (Cathe Wishart)

Heather Smith, a family physician, was on duty that day. Old's wasn't an ordinary case of nerves like Smith was accustomed to seeing in the clinic, she said.

"The first time I saw Barb, she was shaking. She was crying. She was truly beside herself," Smith recalled.

"She looked for all the exits, like she wanted to bolt at any second. And that continued not just from our first meeting but right through our long association with each other." 

Cancer meant confronting her worst fears

The lump did turn out to be breast cancer. Old had to work closely with therapists and a psychiatrist to manage the through her mastectomy and five months of chemotherapy and radiation.

She was prescribed medication to help her sleep, as well as to manage anxiety and depression. She also found it helpful to speak on the phone to a peer support worker who had been through breast cancer.

Old, seen here holding a small white dog at the entrance to her rural property, says she has her iatrophobia managed now but that it hasn't gone away. (Barbara Old)

In advance of her radiation therapy, Old's counsellor arranged for her to tour the radiation room to familiarize herself. She was distraught at the sight of the place. 

"I mean, it's scary for anybody," Old said. "It's very scary to go through cancer. But with the added phobias and all that, sometimes, I didn't think I was gonna make it. All those machines and just the thought of being burned by these machines. It just scared me."

Her cancer is in remission, but her phobia remains

Old's cancer has been in remission for six years.

She said she's grateful to be healthy and for the help she had during her breast cancer treatments. Today, she's retired to Vancouver Island where she has found a new family doctor and a new hobby in raising goats.

However, she said her phobia is not gone.

"I mean, I've learned to control it. I've learned to live with it and manage it," said Old.

"But I also know that I really have to be on top of it, meaning that I have to have a doctor, and I have to go see the doctor, I have to talk to the doctor, and I can't stop. Because if I say, 'Ah, you know, I don't really need it. That can wait,' then I'll slide right back to where I was."


Written by Brandie Weikle. Produced by Dr. Brian Goldman with help from Rachel Sanders.

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