Overmedicalisation – published 13.12.13 BMA News

There are wiser doctors than me who can explain why “doctoring by numbers” is wrong both ethically and on the basis of it being poor medical practice. I’m thinking of the quantification of depression, estimation of renal function and cholesterol measurement for a start. These point to risk factors, rather than diseases, just like the measurement of blood pressure. I know that I shouldn’t fall into the trap of overmedicalising the symptoms of my patients by trying to quantify their symptoms with a test of some sort. But I do.
“You want a blood test?” I ask my patients, “Sure, what for?” as I open up the all-singing, all-dancing mail merge document for our local hospital that enables me to choose any number of blood tests for my patients. There is probably a rational, non-medical reason for my patient’s fatigue, but I find that I am dealing with a high level of health anxiety.
So, at the root of the problem is a patient population that is encouraged to medicalise their problems, by public health adverts on the radio, and cancer-scare stories in the newspapers and fuelled by “cyberchondria” – the use of internet search engines to diagnose symptoms.
And my response to this tidal wave of health anxiety?
Well, to be honest, I tend to surf the wave and go along with it. Partly to appease my patient, partly because I think the only thing that will reassure them is a normal test result, but partly because I too suffer from health anxiety. More accurately, I suffer from health professional health anxiety…
“What if they do actually have hypothyroidism, or Addison’s Disease, or diabetes, or worse still leukaemia?” says a little voice in my head The voice that was planted there when I did my junior doctor training in hospitals where the explanation of all symptoms was sought through a chest X-ray, MSU and “baseline bloods”. Where the wellness of as person is routinely documented through the tracking of inflammatory markers and absence of deviations from the norm consign symptoms into the unexplainable “functional” bucket.
So, I wonder if the over-medicalisation of my patients in general practice is at least in part due to the health anxiety of patients, fuelled by the media and the internet? I wonder too if I collude with them by agreeing to investigations and yielding to my own inability to handle uncertainty. One day I hope that I will have the experience to know, both intuitively and clinically, when investigations are a waste of time and money. I hope to brave enough to stand up to the tidal wave of health anxiety and medicalisation and learn to be to wise enough to normalise. One day.

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6 thoughts on “Overmedicalisation – published 13.12.13 BMA News

  1. I wish my GP overmedicalised – they kept fobbing me off saying my symptoms were due to anxiety – then I was diagnosed with an autoimmune disease. More chest pain and tachycardia symptoms recently, GP still tried to say it was anxiety, (even though the hospital medics disagreed) and I ended up dangerously ill in hospital a few weeks ago and have found out I have a heart condition. So although obviously I am being subjective, I still think if the tests are of low risk, better to over-investigate and give your patients the benefit of the doubt, than leave them to suffer or put their life at risk like me.

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    • Thanks for your comment Alieshia. I think you illustrate my point – I worry that I will miss a rare diagnosis, hence my health professional health anxiety.

      We know that over treating children for viral infections means their parents reattend with them more often in future for more antibiotics. I wonder if over investigation leads to patients coming back more often, perhaps with more trivial things.

      There are two keys to getting the right balance. First, realising that it is OVER investigation that is an issue and not appropriate investigations and the second is what I would call safety netting – when to come back to me in case I am wrong, or things change.

      Thanks again for taking the time to comment ☺

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    • Depends on the doctor, John, and also on the patient.

      Few permutations:
      Anxious dr + anxious pt = multiple investigations
      Anxious pt + relaxed Dr = anxious Dr (am I missing something)
      Relaxed pt + anxious dr = anxious pt (omg something must be wrong)

      Everything gravitates towards mutual anxiety? 😉

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  2. I retired from general practice after 34 years last March – so this is past experience…
    All diagnoses in medicine start with a history: don’t expect patients to be able (at presentation) to know what is – or is not – significant (any HCPs reading this, have you been embarrassed talking to your car mechanic?).
    Patients bring GPs things that *they* consider to be problems – and there are likely to be a number of possible causes, including physical ones: telling a patient that you want to check that this problem – e.g. TATT – Tired All The Time – *isn’t* due to anaemia or a low thyroid or something else which is now easy to check – and treatable – never seemed to upset my patients or be regarded as over medicalising the problems with which they presented.
    I think the trick is in the presentation: not “do you want a blood test?” (which is asking the patient to make a judgement on something he/she doesn’t have the domain knowledge to evaluate – think cars!) but “I think we should rule out… with a blood test”
    I agree, absolutely, that treating risk factors as diseases will lead to unjustified individual patient anxiety and over treatment – not helped by the HMG/pharma/media assumption that sufficient tests and medication on a population basis would improve life – and healthy life – expectation.
    The bad news is that all medicine is a failure: all that money and death is *still* inevitable for all of us!

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