Ask a Doctor: Can I Trust My Doctor Not to Judge My Marijuana Use?

As many patients fill out their admission forms for their healthcare providers, some have concerns that their honesty about aspects of their lifestyle could lead them to receive healthcare bias. Part of being a great doctor or healthcare provider is the ability not to judge patients and their lifestyles. Trust is essential to nurturing.

The patient must trust the doctor with personal information so that the doctor can give the best advice for that particular patient. This requires the doctor or other healthcare provider to show the patient that they are open-minded and that the patient trusts the provider.

But we must recognize that doctors are people with their own prejudices based on their upbringing, world experience and personality.

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When asked by friends and patients who raise concerns about their doctors, I tell them that if they can’t trust their doctor with personal information, they need to switch doctors if possible.

So how do we deal with disclosure of cannabis or any recreational drug use in healthcare? We should start by thinking about both explicit and implicit bias.

Explicit bias refers to a person’s awareness of their pre-existing beliefs and making decisions based on them. These prejudices can often be easily identified by others.

Implicit biases are unconscious beliefs or feelings that can also affect decision-making without the person being aware of their influence.

When there is a conflict between a person’s explicit and implicit attitudes – for example, “People say they have no prejudice but say e.g. B. subtle signs that they are – those on the receiving end can be anxious and confused.”¹

“The individual words doctors use can be a signal of implicit bias. Words like “we,” “our,” or “us” can be used by those of power over those of lesser power. This is made clear by phrases such as “We take our medicine, right?”²

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I’ve always felt that simple, non-aggressive questions on any subject, whether conscious or unconscious, can help clear up confusion. It’s at least worth a try. On the other hand, if the negative bias seems too strong or the fear too great, I would advise switching providers.

A recent online survey found that 81% of patients withheld medically relevant information. Of these, 81.8% withheld information because they didn’t want to be lectured or judged.³ Well, that doesn’t sound like a trusting relationship in general.

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So how do we get through this conundrum: genuine physician bias, fear of patient bias, and withholding information? We must also recognize that there may be positive or negative patient biases towards healthcare workers.

There is weight on the patient’s side of the equation. Regarding cannabis use, I would give the same advice on history taking as on alcohol use, exercise and diet.

First, the patient should be honest with himself. This is best done by keeping an accurate diary of cannabis use; whether medicinal or relaxing or both. This provides the physician with more precise information for assessing patient care. An answer of “only moderately” or “only socially” indicates such a large variance in quantity that it can be misinterpreted. While it’s pretty tedious to do, a two-week consumption diary, along with the effects, can greatly enhance a discussion about cannabis.

Ultimately, I feel that honest, straightforward discussions with accurate information lead to better healthcare. A health professional’s age or type of training does not increase or decrease bias. Research into bias continues, which will improve our knowledge of the issues.

“On a more discrete level, we are attempting to gain a better understanding of how situational factors such as stress and time pressure can activate prejudice and influence treatment decisions.” 4

I like to think that healthcare providers go into their chosen field with an open mind about their patients and their lifestyle choices. Ultimately, healthcare workers are well educated, but they are also people with their own shortcomings who are trying to work with their patients to provide better healthcare.

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¹ Monitor on Psychology, March 2019, p. 33
² Health Communication, Vol. 32, No. 4, 2017
³ JAMA network open. 2018;1(7):e185293. doi:10.1001/jamanetworkopen.2018.5293
4 Monitor on Psychology, March 2019, p. 37