After all, doctors urge patients to stop smoking, lose weight, get vaccinated, have a colonoscopy and so on, Dr. Bock points out. Why not tell them to get married – especially since multiple studies have found that marriage is generally associated with better health?
Here’s an excerpt from his post, via Kevin MD:
Not only 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.
Dr. Bock then shares a story about one of his patients, a 22-year-old unmarried woman with a 1-year-old child. The child’s father has asked her to marry him but she wants to go back to school and isn’t ready yet for marriage. Dr. Bock suggests that she “consider the beneficial social and general health aspects of solidifying her ongoing relationship with the child’s father.”
The patient listens politely. Dr. Bock thinks the conversation was productive. But two days later she calls to let him know she will not be coming back as his patient, ever.
According to the science, Dr. Bock actually has a point. Whether marriage affects health and longevity has been well studied. One of the earliest of these studies was undertaken in the 1850s by British epidemiologist William Farr, who analyzed French birth, death and marriage records and concluded that those who were married generally lived longer and were in better health than those who were unmarried or widowed. Subsequent studies over a century and a half have confirmed Farr’s observations, associating matrimony with a lower risk of pneumonia, cancer, dementia and even likelihood to undergo surgery.
Although it would be easy to conclude that everyone should get married so they can be healthier, the picture is more complicated than this. Later and more detailed studies have found that the type of relationship matters; marriages that are stressful or abusive are worse for people’s health than a happy, supportive marriage. Other studies have noted that people who have married and then divorced are less healthy than people who remained unmarried. The marriage benefit also seems to be strongest for men but less so for women.
The philosophical questions raised by this are intriguing. A recommendation from the physician can have power, especially when it comes in the context of a solid, ongoing relationship between doctor and patient. Patients often will discuss things with their doctor that they might not bring up with someone else. If the goal is to help the patient be healthy, why not suggest lifestyle and social choices that are backed up by evidence?
On the other hand, physicians need to beware imposing their own values on their patients. And anyway, where would you draw the line? Church-going and moderate alcohol consumption also have been linked to better health. Does this mean physicians should start urging their patients to go to church every Sunday and knock back a beer or two each night? Does the promise of better health trump every other consideration or preference the patient might have?
For what it’s worth, virtually everyone who responded to Dr. Bock’s post thought he crossed the line. “Completely and utterly inappropriate,” one person wrote. “You do not know the child’s father, and the patient was not there for social advice.”
A female reader took Dr. Bock to task for imposing his views about marriage on a patient whom he barely knew. “I would no more take personal marital or religious advice from a physician than I would from a mailman – except my mailman probably knows me and my family far better!” she wrote.
What do readers think? Should doctors be talking to their patients about the health benefits of marriage? Or is this a topic that should remain off limits unless the patient specifically asks for advice?
Photo: Wikimedia Commons