Cyberchondria - How to Google Your way to an Illness
The Worried Well Epidemic
Some of us think that we are sicker than we really are. We may misread natural symptoms in our body as indicative of disease. It can be a frustrating journey to the person and their Doctor, often resulting in multiple visits, investigations and no resolution. Contrary to giving relief, normal investigations and a lack of diagnosis often makes the ‘Worried Well’ even more worried. The rise of unreliable health information in the media and especially the internet doesn’t help either (I say with no irony).
It is estimated the ‘worried well’ make up to 18% of the population, according to a 2002 Oxford Workplace Wellness Survey. The extreme form of the worried well can be Hypochondriasis. This is a seriously debilitating form of health anxiety. The affected may constantly check themselves for various illnesses and become very tuned to their bodily functions. Every twitch, every skipped heart beat, every bowel sound can get interpreted as a harbinger of doom. It is tough being a hypochondriac in the modern day as there is so much more health information in the media.
Death of a health relative or a friend, stressful life events, global pandemics can all trigger hypochondria. There will be an obsessive quality to this condition where the worry never really goes away despite negative tests and plenty of reassurances from clinicians and family. The worry may get hidden and becomes a guilty secret often triggering obsessive compulsive episodes.
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Microsoft researchers Ryen White and Eric Horvitz conducted a large-scale study in 2008 on the subject of Cyberchondria. White and Horvitz defined Cyberchondria as the “unfounded escalation of concerns about common symptomatology, based on the review of search results and literature on the Web.”
The Wikipedia lists the new manifestation of hypochondria as ‘cyberchondria’ where the afflicted research their perceived medical problems on the internet.
The trouble with most health information on the internet is that it can be inaccurate; it doesn’t always articulate risks clearly and makes the random and exotic sound more frequent. There is an observer fallacy involved in bad news – it makes us feel it is more common than it is. There are many stories of people suspecting something bad was happening to them, Doctors ignoring them and then going on to being diagnosed with something.
These are powerful stories and can be potentially upsetting to read. However, the reverse is never news. For every story like those there are thousand others where people have pursued a suspicion of an illness only to find they were healthy after all. This is never a good sound bite or a riveting story.
It is also common to ascribe deadly diseases to simple symptoms - anal itch can be common but websites may link it to anal cancer - while anal cancer can start as anal itch there are a million others where the itch is due to a simple, more mundane ailment.
One of the commonest issues with hypochondria and health anxiety is a phenomenon known as somato-sensory amplification. Here, a person will have a tendency to perceive normal somatic sensations- a nervous tic, a rumbling in the stomach, changes in heartbeat, a nerve sensation, simple numbness, sensory changes in skin or an organ as being relatively intense, disturbing and noxious.
This is common in people with anxiety disorders, mild to moderate stress, Depression and Hypochondria.
As physicians rely sometimes on the patients description of these symptoms, this may lead to battery of unnecessary and expensive tests often leading nowhere.
It is not clear whether there is a genuine increase in sensation and amplification or a perceived increase. There is also something called 'attention focusing' where the particular symptom takes over their attention to obsessive levels. The true test here will be whether the symptoms are more obvious when sitting quietly and otherwise unoccupied ( happen in Somato-sensory amplification) and less so when otherwise occupied and engaged in other activities.
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Cost of Hypochondria
Hypochondria is often associated with anxiety and obsessive compulsive features. This also results in reduced faith in Medicine and the establishment and makes one susceptible to quackery. ( Although some are untrustworthy anyway!) There are several entrepreneurial quacks who would love to take advantage of the worried well.
The Worried well spend thousands on multivitamins, health interventions of little value and self-diagnostic tests . There is a strong market peddling on peoples worry and suspicion of traditional health model. Although there are very good alternative remedies such as herbal supplements, ayurvedic therapy, Massage, Yoga etc. there are equally some dubious cures and quacks out there and you have to be careful.
Where are the Healers?
Trouble is traditional Western medicine has become over reliant on tests, scans and a motley investigative methodology that it has stopped listening to people with care and attention. This patient centred narrative methodology is what helps people to feel listened to, understood, explained and healed. This is such a shame as the scientific medical advancements that have resulted in people living longer and longer but not necessarily happier. We currently enjoy some of the best medical advancements in the history of medicine yet the relationship between healthcare and people can be strained to say the least with trust broken in some situations.
We need more healers who can straddle the western medicine with eastern mindset. Healers listen, respond, advice, share and suggest tailored cures that are patient specific. They take into account the patient's lifestyle, background and personal circumstances to combine a holistic management plan that may include modern tests and medications but also caters to the worried soul. They give patients choices and help make the one best suited. They often prefer to have a long term strategy of prevention and lifestyle modification, but will be quick to spot anomalies and situations away from the norm.while pattern recognition is a key skill for a clinician so is recognising outliers and errant symptoms that indicate illness.
Firstly one must not assume that they are a hypochondriac if they get a symptom that needs assessment and investigation. However if there has been a trigger traumatic incident - like a disease or death in a close friend or family, which then causes a persistent worry or anxiety this could well be an early sign.
It is always safer to consult a clincian and have an open chat. Put the cards on the table and explain the symptoms, signs and any trigger incidents. Cognitive behavioural therapy is very helpful if any persistent hypochondria is identified.
There are too many stories of 'missed' diagnosis and scary anecdotes that can skew ones perception of health. While some are true enough ( God knows I know a few!) in most circumstances the modern investigative abilities are very good and often clinicians are good at ruling out the nasty illnesses. Trouble is they often forget you once they have ruled out anything 'serious' leaving you still with the original symptoms and no explanation. Good family practitioners, someone who knows you for long and can be your guide, is worth their weight in gold. they can often act as a hub for your discussions while referring you on to specialists should matters get out of hand and if a clear picture of an illness emrges from the tests and clinical assessments.
More and more studies are proving that well trained Family practitioners are a boon to any health care organisation. Training in communciation and consultation skills as well as medical specialities helps identify potential problems early and treat accordingly or reassure well.
The survey also classified respondents into another three categories: The ‘Truly Healthies’ are those of us who are well and have not been to the Doctor at all apart from occasional jaunts for holiday jabs and insurance medicals. The ‘Realists’ are those who may have acute or chronic diseases and may have to attend Doctor's surgeries and hospitals for these reasons and do rightly so.
But it is the fourth category that concerns me the most. These are the ‘Deniers’ who may be 17% of the general population. We are deniers if we have had some convincing physical symptom or a sign; say a mole that has grown darker and irregular; blood from any orifice; a significant lump; a worsening symptom that has continued over and beyond good reason. The trouble with being a denier is that we tell ourselves that if we wait long enough it will go away.
We also worry ourselves silly about all the wrong things, that the Doctor or Nurse will think we are being paranoid, overcautious or downright silly. We may be so frightened of what the clinicians are going to find out that we’d rather not hear it. While the worried well have no qualms about ringing their Doctor and demanding an appointment, the Deniers are terrible at seeking help. They also avoid screening tests and health checkups, as they believe if they don’t get it checked, it won’t happen!
Even when they do arrive at the appointment, they commit that classic sin of playing down the symptoms and blaming the family or friend for nagging us into going there in the first place. The Deniers feel shy that they may be mistaken for a hypochondriac!
So if you are denier, do yourself a favour and get that looked into, whatever it is you have been hiding and secretly worrying. Because you are worth it.
© Mohan Kumar 2013
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© Mohan Kumar 2013
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