Sabotaging one's own medical care. Prevalence in a primary care setting

This study determines the prevalence of medically self-sabotaging behaviors reported by patients in a primary care setting. A 19-item self-report survey was completed by patients on-site at the Family Medicine Clinic, University of Oklahoma College of Medicine-Tulsa. Four hundred eleven consecutive male and female patients were seen for nonemergent care. Each of the 19 items was endorsed by at least 1 respondent. The most commonly endorsed self-sabotaging behaviors were not seeking medical care when needed (37.2%) and not taking a prescribed medication (25.1%). Significantly more women (26.4%) than men (17.5%) reported not taking a prescribed medication (P < .05). After excluding these 2 commonly endorsed items, 27 (6.6%) of the respondents reported at least 1 other self-sabotaging behavior, with most indicating 1 (63.0%) or 2 (22.2%); the remaining 4 individuals reported 4 to 12 behaviors. Significantly more men (4.8%) than women (0.6%) reported not following instructions from a physician or nurse to prolong illness (P < .05). A few patients (6.6%) seen in a primary care university outpatient clinic acknowledged the active and intentional sabotage of their medical care, beyond not taking a prescribed medication or seeking medical care when needed. This is probably a conservative estimate and indicates that medical care is actively compromised by a few patients.