A recent trip to my GP in a state of heightened anxiety, followed by various examinations and (fortunately) considerable reassurance, prompted me to go online to check out what there was on the category of people known as the 'worried well'.
The 'worried well' are those who consult their doctors because they are worried that they might have, or catch, something, even though they are fine at the time. The phrase was devised in 1970 by American doctor, Sidney Garfield who worked in healthcare and medical insurance. Dr Garfield realised that when medicine was on a 'fee for service' basis, people avoided visiting the doctor, often with ill consequences for their health. By changing to a pre-payment system, people were probably likelier to consult a professional at an earlier stage. The downside to this system was that it opened up the floodgates for worried patients, who used up doctors' surgery time and resources that could be better spent on genuine patients.
In the US, approximately 13% of physician visits every year are for medically unexplained symptoms. Often patients report persistent physical symptoms, but no physical origin can be found. Doctors may try to explore the psychological basis of the symptoms, but this uses what is considered to be valuable time and resources with no satisfactory result for the patient.
A new condition has been termed "cyberchondria', where the worried well use the internet, in particular "Google', to diagnose their condition. Apparently 80% of Americans have searched for medical information online. 75% of those don't check out the quality, validity, or date of the information.
A recent study conducted by Microsoft reviewed logs of 515 individual’s health-related Web search experiences. One of the main findings was that search engines can actually escalate medical concerns.
This is due to the amount of medical content viewed by searchers, the existence of an increasing amount of terminology in the Web pages, and the searcher’s tendency to escalate his anxiety rather than looking for more sensible explanations for physical symptoms.
The research found that post-session anxiety lingers after escalations of medical concerns. The information obtained from the Web also influences people’s decisions about visiting their doctor, diagnosing or treating ailments. The study also learned that some users of search engines interpreted the ranking of the Web search results as the likelihood of the illness. The Web can therefore be a dangerous place for people to seek advice. Not everyone who uses Web-based information will be misled, but the potential for this is considerable.
I can relate to this, especially recently. Websites can list symptoms of certain conditions, ending with a statement 'If you have any of these see your doctor'. I mentioned this to my GP who muttered something about not reading info on the internet. There's a balance, though. We need to be alerted to symptoms which could indicate, if not serious conditions, those meriting treatment or lifestyle advice. But some information leaflets can be scary. Especially for people like me, the health-anxiety prone, the cancer-phobes. I accept that I am a 'worried well' person. Someone with enough knowledge to worry and not enough to reassure myself there is nothing to worry about.
Being an 'unworried well' person would be better. I've known people happily going off on holiday, with an appointment for a colonoscopy ( detailed examination of the intestines) following their return. And occasionally you hear GPs jokes about patients who come to see them, reporting that they've had diarrhoea for 20 years and want to have it sorted because they are just about to fly to Canada to see their grandchildren. Are they the 'unworried unwell'? After all, a course of immodium is unlikely to remedy two decades of the runs.
In the UK, reports that the “worried well” could account for up to almost a fifth of GP appointments costing up to £2 billion annually, are causing concern in the medical profession. In March last year, Dr Iona Heath, the president of the Royal College of General Practitioners, reported that the NHS is spending too much money on treating the 'worried well' rather than patients who are actually sick. She stated that it was vital to concentrate on people who are suffering now rather than those who may or may not become ill in the future.
There has been a huge increase in NHS spending on public health campaigns warning the public about the dangers of alcohol, smoking and unhealthy eating. Furthermore, the cost of treating obesity is likely to rise from £2billion per year to nearly £5billion per year by 2025 and the NHS is spending nearly £1million a week on fat-fighting drugs. Dr Heath stated that In the name of prevention being self- evidently better than cure, health care funding is being systematically diverted away from the sick and towards the well, exemplifying someone who spends years being treated for high blood pressure and high cholesterol - only to die of a rapidly invasive thyroid cancer.
There's an alternative view, however. A recent Government-commissioned report called for the NHS to spend even more on preventing illness. The strategy is designed to help reverse the trend that sees Britons from disadvantaged backgrounds suffer more health problems than wealthier people. Supporters of prevention believe long-term savings outweigh the future cost of treating the ill. The Department of Health said: 'With an ageing population and the increased prevalence of lifestyle diseases, preventing illness and keeping people healthy is our best long-term insurance policy for the nation's health and managing the financial challenges ahead.'
The UK NHS Breast Screening Programme provides free breast screening every three years for all women aged 50 and over. A newer programme aimed at reducing mortality from bowel cancer, invites all men and women in Scotland between the ages of 50 to 74 for screening every two years. And the cervical screening of all women aged over 25 has been around for a long time. In some other European countries screening is even more widely available. In France there are routine screening campaigns for four of the most common types of cancer: breast, prostate, cervical and bowel.
The rationale for these is the knowledge that early detection of many cancers greatly affects the prognosis, in some cases pre-cancerous conditions can be spotted and treated to prevent the cancer occurring.
Further afield, in 1981 Australia introduced a huge health promotion campaign on skin cancer: SLIP, SLAP, SLOP: slip on the long-sleeve shirt, slap on the sunhat, slop on the suncream. This campaign was so successful that it managed to achieve what might be considered the unachievable: a change of attitude towards a sun tan. No longer was tanned skin considered attractive. It was now deemed a health risk. Since this campaign was introduced along with advertisements, the incidence of the two most common forms of skin cancer (basal-cell carcinoma and squamous cell carcinoma) in Australia has decreased.
Unfortunately, the incidence of melanoma - the most lethal form of skin cancer - has increased. A study published in 2002 concluded that those skin cancer increases couldn't be associated with the use of sun creams, and recommended continued use of the current campaigns as a means to reduce melanoma risk. However, a connection has been made with the increase of Vitamin D deficiency (which can lead to cancers), since sunblock also prevents vitamin D production in the skin. Doctors have therefore recommended spending small amounts of time in the sun without sun protection to ensure adequate production of vitamin D. Nothing is ever simple.
Health education is only part of a process of enabling people to become healthier. Often the problems are to do with lack of access to healthy food, for example. And this is where health inequalities are very much alive and lashing out. If you don't live within reasonable distance of a shop which sells fruit and vegetables, it can be difficult to acquire these goods even if you can afford to pay for them. So, governments, both at national and local level, have a huge part to play. There could be price manipulations by supermarkets, for example, where a packet of biscuits isn't half the price of a pound of apples. Cans of coke could become pricier and a carton of fruit juice cheaper. There could be an increase in the number of fruit and veg co-ops in low income areas. There are also implications for public transport systems: having buses to take people where they want to shop for food. Dropping the price of suncreams would help. The list goes on.
The NHS should continue to offer screening programmes. It's the old adage of 'a stitch in time saves nine'. GPs should have the training and the consultation time to allow them to reassure neurotics like me. Mine was lovely, the other day. I acknowedged that my first reaction to a symptom - any symptom other than a sneeze - sends me spiralling downwards into a anxiety state so acute as to be almost paralysing. Some doctors are wonderful at understanding this and dealing with it. There are also doctors highly skilled at giving bad news. A friend who has a pre-cancerous condition considers herself fortunate enough to consult a surgeon who can communicate in a way which makes any information feel manageable. No small achievement.
In the meantime I continue to work at the health promotion advice I was already following but whose importance my GP gently reinforced.
Twitchily yours
Jane
Ref. http://virtuallinguist.typepad.com/the_virtual_linguist/2011/01/the-worried-well.html
http://www.dailymail.co.uk/health/article-1256263/NHS-wasting-millions-treating-worried-well.html
http://brainblogger.com/2010/01/13/worried-well-on-the-web/
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