Could Have Been the Whiskey, Might Have Been the Gin: Blaming the Victim in Healthcare

Does anyone else feel like their intolerance for insensitivity is getting more and more pronounced lately? Is it age? Is it the pandemic? Is it just the overwhelming amount of unnecessary information that we have to process every single day? 

I ask because I almost got myself booted off of one of my favorite professional websites today. Those who know me understand that I am not usually a “leave a comment” kind of person. My patience is worn thin, though, from hearing an increasing number of people say things such as:

  • “He had it coming to him.”
  • “Well, that’s what happens when you live on burgers and beer.”
  • “Maybe he should have gotten off the couch every once in a while.”
  • “If she would have taken her medicine, this wouldn’t have happened.” 
  • “She shouldn’t have been there that night.”
  • “What did he think was going to happen?” 
  • “She’s just crazy.”

Let’s talk about Helen, a woman I know who had struggled with what appeared to be a variety of odd health problems for most of her life. In middle-age, Helen put her seemingly disconnected set of symptoms together and concluded that she seemed to fit the profile for a specific genetic disease. She mentioned it to her doctors; they said that it wasn’t outside the realm of possibility. She was tested and was positive. She researched and found that a specific type of medication might be helpful and might extend her lifespan. Again, she asked her doctors their thoughts about her research, and they said, “Hey, that might be a good idea.” She started on the medication, and shortly after, she began to have a problem with her feet. She researched the issue – yes, it might be related to the medicine. Unfortunately, her trusted physicians were not in the office when she finally decided that enough was enough.

The covering practitioners were too busy ordering tests and admonishing her for wearing open-toed shoes to her appointments to pay her question about potential side effects of medications any attention. They were highly focused on her shoes – almost to the point of absurdity. She told them, “I can’t wear close-toed shoes because my toes split open, and it is excruciating.” She did not bother to remind them that she had been working from home for over a year and had only worn shoes once a week or so to go and pick up groceries. She didn’t waste her breath explaining that this was the first time she’d worn anything but sneakers in a year. She had already told them that her toes had been a mess through four seasons and that the temperature seems to not affect her symptoms. After several thousand dollars worth of testing and four long trips to various doctors, guess what? It wasn’t the shoes. It was the medication.

Yes, I could have been a bit more tactful when crafting my response to a physician’s comment in an educational piece about Helen’s condition. “Maybe she should have worn socks,” he wrote. You could almost see his self-impressed smirk as he sat all cozy in his office, comforting himself with the knowledge that this patient did it to herself. Except what if she didn’t? What if she had a vascular disease compounded by the use of beta-blockers? What if she never found out because no one bothered to look at her list of medications and her medical history and put two and two together? What if she wasn’t capable of advocating for herself?

While it’s true that some health problems are caused by things like sitting too much, poor hygiene, or wearing inappropriate footwear, those same conditions can also be caused by immune problems, uncontrolled hyperglycemia, or the side effects of prescribed medications. 

Many studies have shown that people who blame themselves for their health problems and believe that their doctors will also blame them are less likely to seek care. Many of us would rather die quietly and ashamed than face the judgment of a health care professional or to know with certainty that we have, possibly irreparably, harmed ourselves. 

Turn on the news for ten minutes, and you can see what happens when we scandalize those struggling with mental health issues. Unfortunately, it’s not just psychiatric care that is abandoned out of shame. People struggling with mental health and substance abuse disorders often die prematurely from untreated chronic illnesses such as diabetes and heart disease.

The unsavory truth is that our behavior is much more than the choices that we make. Our actions are often based on genetic and environmental factors. When we blame someone for their health status, we often shame them for being poor and uneducated. 

Medical notes often start with something along the lines of, “Medically non-compliant and obese smoker admitted with chest pain.” The last thing mentioned is the chest pain; it’s almost an afterthought.

Dougherty, C.J. Bad faith and victimblaming: The limits of health promotion. Health Care Anal 1, 111–119 (1993). https://doi.org/10.1007/BF02197104

Heisel, W. Flying blind: Why do we keep on blaming victims of medical errors? USC Annenberg Center for Health Journalism. March 20, 2017. 

Lewin, E. Victim blaming is an ineffective health tool. newsGP. May 29, 2019. 

Richards H. Victim-blaming revisited: a qualitative study of beliefs about illness causation, and responses to chest pain. Family Practice. 2003;20(6):711-716.