Should doctors give marriage advice?

Doctors have no trouble or compunction giving these good pieces of advice:

  • stop smoking
  • lose weight
  • eat less saturated fat
  • wash your hands
  • vaccinate
  • schedule your mammogram
  • get a colonoscopy

These all likely can augment both life quality and expectancy.

Do doctors, then, (in appropriate situations obviously) go the extra mile and tell a patient to get married? There are reasonable reports church-going adds to longevity, but with sensitivity to broaching religious beliefs, doctors may be reluctant to suggest Dr. Daniel Hall’s advice, “take two prayers and call me in the morning“, even though actuarial death rates found that weekly worship service attendance could add up to three years to a person’s life.

But what is holding them back about advising marriage? We are certainly at a juncture where this advice could prove a crucial difference in how well our society holds up in the upcoming decades. Even Social Security is worried about the relatively poor health of the unmarried, and never married.

Studies show that people live longer married. And that’s not even a joke (you remember this one: “Do married people live longer? No, it only feels that way” ). That’s the sentiment of the popular culture: movies, TV shows, magazines, and mainstream media. Marriage is there to be mocked.

Not only does do people live longer married, but they live wealthier and happier, and this conclusion remains even after you factor out preselection towards marriage people you could argue that maybe those destined for poorer life expectancies never marry in the first place but probably the opposite is true, people who need care and caring tend to marry at a higher frequency.

A 22-year-old woman was in my office recently. She has a 1.5-year-old baby, lives with her own mother, is on state-benefits. The infant’s father lives in the next town over, works, and had asked to marry her. She said, “I’m thinking of going back to school at some point … so, I’m not ready yet.”

But is her baby ready, yet? Children in married households have more resources, not just physical resources, but emotional, instructional, and familial. In this case we’re not talking just about the patient’s health, harmful activity avoidance and longevity; but, in the long-run, probably those of the offspring as well.

So, “take two wedding-rings and call me in the morning.”

 

Postscript: This note was partly inspired by the occasion of the visit of the 22-year-old quoted above. She was in for a visit to “meet the doctor.” She had a little bit of back pain and a fair amount of obesity, which we addressed with standard medical advice. It was during this visit that I tried the “health intervention” advice of suggesting to this young lady to consider the beneficial social and general health aspects of solidifying her ongoing relationship with the child’s father. She seemed to acknowledge this and consider it in a reasonable fashion, and we had what I had thought was a productive conversational visit. She called a couple of days later announcing she will never be coming back, so perhaps take what I say above with a grain of salt until this concept percolates through to society with the same weight and force of other standard medical advice dicta, or don’t attempt this until many visits have transpired.

Randall S. Bock is a primary care physician who blogs at
Doctoring the Evidence.

 

Submit a guest post and be heard on social media’s leading physician voice.

Comments are moderated before they are published. Please read the comment policy.

  • ErnieG

    The advice to “solidify her ongoing relationship with the child’s father” was completely and utterly inappropriate. You do not know the child’s father, and the patient was not there for social advice. A physician is not a relationship counselor. It would be appropriate for you do ask her if she could benefit from discussing her thought processes about her decision to marry or not marry with someone, and offer general resources- anywhere from talking to a friend whose advise she values to talking to a social worker to (if religious) a clergy member- and that’s it. For goodness sake, what if he was abusive?

    • Reasonable Patient

      My thoughts exactly. Abusive, or at least unsupportive of her going back to school, which could, in the long run, be better for her AND her child.

      Patients will not usually feel comfortable speaking up if they feel that a doctor’s personal questions/advice are out of line, especially at a first meeting. There is not enough time to get to know the patient as a person, and get into these topics in a respectful way. That is, not if you’re also going to do medicine and deal with the patient’s physical health.

      I’d hate to even ask what this doctor’s attitude might be toward LGBT patients.

  • Taylor

    Ummmmmm, seriously?! Even with the few facts you had, your advice was completely inappropriate and way off base! Like the above comment, you don’t know anything about their relationship. This is definitely advice that should come from a friend or family member. Heck, even if I was in this situation and my mother gave me such advice I wouldn’t really listen UNLESS I ASKED FOR IT?! When it comes down to it, it’s my life and my relationship so I’ll do what I want. You seem like an old fashioned, backwards thinking person with the whole, “women are best utilized in the kitchen” mindset. I am 26, unmarried, have a successful career, and no kids. Will I get married? Who knows. I definitely won’t in the next year and if I ever do marry, it won’t be because it’s what you and some of society thinks I should do! (Sidenote: I am in excellent health, physically fit, and eat well. Who knew I could be those things without a husband?)

  • Angela Caffaratti, MD

    As a physician, I too think it is important to give advice but only generally. If I see a thirty-something year old single woman living with a man for years, I suggest that she consider hard about if this is the right person for her or not. If she wants to have childre, she is running out of time and shouldn’t be wasting it on somebody she isn’t serious about. I tell her to realize celebrities having children in their forties are using surrogates or extensive medical tinkering. I also tell young people to simplify their lifestyle, work less and spend more effort on their educationy. I also tell people not to work overtime indefinitely so that they can live better. Generalities.

  • http://fertilityfile.com IVF-MD

    For a physician, when patients specifically ASK you for marital advice, you have an opportunity to help improve their lives, such as with this post that I wrote last week

    http://fertilityfile.com/?p=868

    However, I clearly see the pitfalls of giving advice on private matters that were not volunteered to share with the doctor.

  • http://myheartsisters.org Carolyn Thomas

    Dr. Bock, your essay would be truly hilarious on so many levels – if it weren’t so utterly archaic, off-putting and ill-informed.

    First, the “studies” you link to are, of course, based on research done on married MEN, not on married women.

    While it may be true that men who are married – happily or not – are generally healthier than their unmarried buddies, you may be unaware that this is not the case for women.

    It’s also a stretch to assume that your 22-year old’s recommended marriage would be a happy or long-lasting one. A man’s physical health does apparently benefit simply from the state of being married, whether or not he rates it as a good marriage.

    But a woman’s overall health can be significantly threatened by trouble at home, according to researchers at the University of Utah. Women in fact respond to unhappy marriages by being three times more likely to develop serious cardiac risk factors that can lead to heart disease.

    Women who report marital strain also have higher incidence of depression, high blood pressure, high LDL cholesterol, obesity and other signs of metabolic syndrome.

    What about single, divorced, or other women who are “between husbands”? After accounting for a variety of factors, the Utah researchers found that there were NO STATISTICALLY SIGNIFICANT HEALTH DIFFERENCES between happily married women and unmarried women. More on this at “Poor Marriage = Poor Heart Health For Women” at HEART SISTERS – http://myheartsisters.org/2009/06/29/poor-marriage/

    It also sounds like you met this 22-year old woman for the very first time for a ‘meet the doctor’ visit – and yet you apparently had few qualms about imposing what is basically your personal beliefs about marriage upon her?

    I would no more take personal marital or religious advice from a physician than I would from my mailman – except my mailman probably knows me and our family far better!

    Perhaps the end result that you’ll never see this patient ever again after your “health intervention” attempts may have you re-thinking the wisdom of assuming that everybody is just like you.

  • http://warmsocks.wordpress.com/ WarmSocks

    Unlike some of the other commenters, I think that pointing out factors that the mom might not have considered having an impact on her child’s health was a great idea.

  • Finn

    I’ll second Carolyn Thomas: “People” don’t live longer if they’re married; MEN do. Apparently you’re more concerned about the longevity of some man you’ve never met than about the health of your own female patient.

    And need I point out that correlation is not causation, so marrying does not mean that this man will necessarily live longer?