Iatrophobia

Iatrophobia is the extreme fear of medical attention, even with signs of a serious illness. The term "iatrophobia" comes from the Greek words "iatros," meaning healer, and "phobos," meaning fear. While there is no information regarding the prevalence of iatrophobia specifically, a survey found that 1 in 3 Americans avoid going to the doctor, even when they feel it is necessary. Rates of iatrophobia likely increased following the COVID-19 pandemic, where individuals experiencing iatrophobia avoided testing for the virus or visiting a physician with symptoms.

Signs and Diagnosis

A situational-specific phobia is defined as an extreme or irrational fear of or aversion to particular situations. While it can be common to feel nervous before a doctor appointment, iatrophobia expands beyond a general anxiety for medical experiences. Signs of iatrophobia include, but are not limited to:

• Postponing or rearranging medical appointments, neglecting preventive care, or missing vaccinations.
• Managing symptoms independently rather than consulting a healthcare professional.
• Experiencing elevated blood pressure in clinical settings, known as white coat hypertension.
• Difficulty sleeping, skipping meals, crying, or struggling to focus due to anxiety about an upcoming medical visit.
• Feeling fearful of healthcare providers, hospitals, or specific illnesses, beyond just a fear of doctors.

In the recent past years post-COVID-19, people have become more wary of doctor visits due to virus exposure, and negative experiences during the pandemic, such as uncomfortable or painful swab tests, have created fearful attitudes towards clinical experiences. People with iatrophobia may be less likely to seek testing after a known virus exposure or symptoms.

Formal diagnosis according to the American Psychiatric Association (APA):

• Experience an intense fear of doctors or medical tests for at least 6 months
• Symptoms begin or worsen when visiting a doctor, undergoing medical tests, or even thinking about such situations
• Intense fear or anxiety that leads to avoiding medical visits or tests, even when you're feeling sick
• Physical or emotional symptoms that negatively impact your overall health and daily life
• Overwhelming fear, anxiety, or a sense of dread that is out of proportion to any actual medical threat

Consistent avoidance of medical treatment can put patients at serious risk of medical issues and disease complications that affect future quality of life and longevity. Regular medical exams and tests, such as blood pressure and cholesterol levels, are crucial to sustaining good health.

Sociopolitical contributions

Race

The historical treatment of people of color–especially of individuals in the Black community–has impacted, and continues to influence, the quality of the medical care they receive. It has also transcended boundaries between physicians and their patients, affecting consent and their prescribed medications. Iatrophobia is particularly common in communities of color given past medical experiences, best described as “the transgenerational transmission of racism [that] encompasses the historic racialized experiences of entire peoples and the stories of race and racism they pass down through the generations.”

In 1961, Fannie Lou Hamer felt a “knot” in her stomach, leading her to seek medical attention in a hospital. Upon her return to her family’s shack on a plantation, she learned that her surgeon had not only removed a benign tumor–they also removed her uterus, leaving her sterile. The sterilization of specifically Black women was common in the mid-1900s as a component of the eugenics movement. Originally popularized by German doctors at the start of Hitler’s reign, eugenics sought to pass down solely “desirable” characteristics to future generations of children. In controlling Black communities, “eugenics was appropriated to label Black women as sexually indiscriminate and as bad mothers who were constrained by biology to give birth to defective children.”

This belief caused institutions, like “family planning centers,” to understand and implement the “best way of reducing the Black population by promoting eugenic principles.” During this time, “visual or verbal evidence of African ancestry was enough to justify immediate secret sterilization in on-side clinics under Special Commission No. 3.” Eugenic principles were similarly publicized in the media, including in the film The Black Stork, where the creator, Dr. Harry J. Haiselden, “repeatedly equated black with ugliness and undesirability.”

The eugenics principles were the root of the common treatments we see in practice today. Margaret Sanger, founder of Planned Parenthood and birth control advocate, used her belief in eugenics to target communities of color and of individuals with disabilities to reduce the number of children they conceive. Many of the current gynecological practices were developed by the “Father of Modern Gynecology,” James Marion Sims, who performed his original research on enslaved Black women without anesthesia and, most importantly, without their consent.

It is crucial to understand the history of medical treatments in communities of color to contextualize iatrophobia today. The knowledge of why people of color may avoid medical attention can assist physicians as they work to find methods of care that will better suit their patients.

Gender

The relationship between gender, race, and medicine has a deep historical basis that continues to shape modern experiences with healthcare. In particular, the concept of iatrophobia—a fear or distrust of medical institutions—has been transmitted across generations, especially within communities that have experienced gendered and racialized harm. Women are also more likely to develop phobias, especially anxiety disorders. In this way, this historical trauma is not simply individual but collective, and it extends to the avoidance and distrust of institutions and systems.

In the context of American history, women have long been dismissed and discriminated against within a patriarchal society, and the medical field is no exception. Many women's fears of medical treatment are shaped by intergenerational narratives—stories passed down from mothers, grandmothers, sisters, and other female figures—of neglect, dismissal, or mistreatment. These shared experiences have fostered a legacy of caution and skepticism toward medical care.

The legacy of eugenics further deepens this mistrust. In the early 20th century, efforts to control reproduction disproportionately targeted Indigenous communities, African Americans, disabled individuals, and the poor: these practices were framed as public health or population control efforts but were rooted in systemic oppression. By 1983, African American women—who made up just 6% of the U.S. population—accounted for 43% of those sterilized through government-sponsored family planning programs. Fannie Lou Hamer famously referred to this practice as the "Mississippi Appendectomy," a term used to describe the involuntary sterilization of Black women without their knowledge or consent.

This history of medical violence is further underscored by the foundations of modern Obstetrics and Gynecology. The specialty largely rests on the work of J. Marion Sims, often called the “father of modern gynecology.” However, Sims' experimental surgeries in the mid-1800s were primarily conducted on enslaved Black people in Montgomery, Alabama, without the use of anesthesia. His legacy exemplifies how racial and gendered exploitation were embedded in the development of medical knowledge, contributing to enduring mistrust among communities that were dehumanized in the very creation of the Obstetrics and Gynecology field.

Understanding the historical intersections of gender, race, and medicine is essential to addressing the deep-seated mistrust that persists within historically marginalized communities. Iatrophobia reflects lived realities and generational trauma rooted in systemic neglect and abuse. These histories are not confined to the past, and they continue to inform how individuals engage with healthcare today. Reckoning with the dual nature of medicine—as both a place of healing and a source of harm—requires a collective effort to rebuild trust, center patient voices, and hold institutions accountable.

Recommendations

Iatrophobia in the physician-patient encounter

The conceptual framework finds that the determinants of iatrophobia are found in three categories: patient fear of illness and the medical exam, patient fear of physician reaction, and patient fear related to barriers to care. These categories represent influences from individual to more system-related factors associated with the physician-patient relationship.

Iatrophobia, the fear of doctors or medical treatment, presents a significant challenge in the patient-physician encounter. Patients with this condition:

• may delay seeking necessary care
• withhold critical information
• low levels of medication concordance
• exhibit heightened anxiety during medical visits
• limit information from patient and gain of knowledge from physician

All of which potentially compromise diagnosis and treatment outcomes.

Techniques to implement

Physicians encountering patients with iatrophobia must approach interactions with heightened sensitivity, employing techniques such as:

• transparent communication
• shared decision-making
• gradual exposure to medical procedures

Establishing trust through active listening, validating concerns without judgment, and maintaining a calm, predictable environment can help mitigate anxiety. The physician's awareness of nonverbal cues—both their own and the patient's—becomes especially important, as does consideration for the power dynamics inherent in medical settings. Ultimately, addressing iatrophobia within the clinical encounter requires patience and a collaborative approach that acknowledges the patient's fears while gently guiding them toward appropriate medical care.

Additionally, some studies have shown that the current foundation of race and class bias often contributes to iatrophobia in patients and increases the rate of negative relationships in healthcare between physicians and patients. Some strategies to specifically address mistrust and racialized experiences could include:

• improving provider diversity and opportunities for race-concordant interactions
• creating spaces and communication frameworks that may improve therapeutic relationships
• race-conscious approaches to research that prioritizes perspectives of Black patients