Many of us worry about our health. The culture of medicine and the way technology has shaped our relationships with physicians has given us a powerful message: If you are nervous about your health, see a doctor and she or he will perform a test or prescribe a medicine so that you don't need to worry anymore. As consumers of medicine, it can be tough to know when and if we should listen to our doctors.
We have all been cautioned lately about the rush to get certain medical tests. A recent New York Times article points out that even some physicians think we are being over-tested. It's not just medical tests that are under scrutiny. There have been recent challenges regarding certain medications that presumably lower risk of death. There have also been questions about the real story blood tests tell about the meaning of what is going on inside of our bodies. For example, remember the notion that high-density lipoprotein levels (HDL) reduce risk of developing heart disease? This assumption is one of many that are currently being questioned.
Many factors contribute to our being over-tested and over-medicated. There is some data that American doctors might be more in the habit of prescribing medications instead of counseling patients on behaviors that might reduce the need for medication in the first place. And though there are many other familiar suspects we can blame regarding excesses in health care -- such as pharmaceutical companies, the influence of medical device corporations, and even the greed of some physicians -- what is missing from the discussion is how some patients are anxious, deeply anxious, about their overall health.
Erik Rifkin, Ph.D. and Edward Bouwer, Ph.D. are no strangers to the ways that all of us can get confused and nervous about whether or not we should follow advice from physicians and the medical establishment. As authors of the 2007 book, The Illusion of Certainty: Health Benefits and Risks, they offer an appraisal of medical research and break down the truth about what the data says and does not say about medical assumptions. Dr. Rifkin confers with the idea that the "worried well" can feel confused about what to do regarding medical recommendations. He stated in an email interview, "Individuals who are not obviously ill or in danger, but aging, reading articles about medical interventions in newspapers and magazines, perhaps with a few aches and pains, maybe lost a friend or two through cancer or a heart attack, are uncertain about what, if anything, they should be doing."
Our fear does seem to be a major component of what drives us to seek help. Yet, it is one thing to conceptualize medical worries as being due to anxiety and another to tell people to avoid certain tests or medications. One example of this is related to findings regarding cholesterol. Millions of us are told that we are at risk for heart disease due to high levels of low-density lipoprotein (LDL). Yet, Rifkin and Bouwer report, using data from the MRFIT study, that "In a group of 1,000 individuals with elevated cholesterol, there will be approximately one additional death from coronary heart disease annually when compared to 1,000 individuals with normal cholesterol."
In light of this sobering statistic, I asked Dr. Rifkin what he thought about the millions of us who take statins. Dr. Rifkin made it clear that he could not offer medical advice. Yet, his thoughts were illuminating. Regarding statins, he said, "For individuals without a history of heart disease, the benefits are very low. Taking statins can result in serious contraindications. So, once again, patients need to obtain the information necessary to make a decision regarding the use of statins." The cost of cholesterol monitoring and statin use is high. When patients take statins, they need additional monitoring due to a myriad of side effects, including effects of statins on the liver. Rifkin added, "Estimates of the cost of screening adults without heart disease for high cholesterol include follow-up drug therapy as well as the screening test, and range from about $10 billion to more than $60 billion per year, depending on the drug used."
However, not everyone agrees with Rifkin's and Bouwer's conclusions of the MRFIT study.
Many of us simply just don't know what to do (or what the data means) in regards to taking care of our bodies. What should we trust?
For many of us, anxiety motivates us to take action. In the case of medical worries, we often expect our physicians to act in ways that will help soothe our anxiety. Not all patients want tests or drugs, but many do. Through this lens, physicians may be acting, at least partially, based on patient demands. Physician actions, whether because of our urging or without, may be costing us. These costs are not only financial, but also physical, given the side effects and complications of many medications and diagnostic tests.
For those who are worried about their health, there may be additional venues to deal with anxiety. Health psychologists can be a great starting point. That said, there are many things that we would like our physicians to reassure us about. This is not unreasonable, but being a consumer in medicine is a bit like buying a car. You don't get ripped off if you do your research ahead of time.
It is difficult for patients to ask questions that challenge physicians' authority, but all of us should do so. And we should seek education from reliable sources. Physicians need to do a more balanced job of explaining the risks and benefits of medical treatments and tests. However, we alone are responsible for our own health. Physicians are guides, but we all need to feel more entitled to direct our medical care. Challenging the authority of physicians and the medical establishment is not only okay, it may be the only way we can assure quality care in this complicated terrain of 21st-century medicine.
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