Driven by Fear
The response to my last newsletter, Measure Twice, Cut Once, discussing the dangers of unnecessary surgery was met with such positive interest that I have decided to build upon that theme by taking up another unspoken dark side of medicine: fear. Let me say at the outset that as a medical doctor I have a tremendous respect for the body of accumulated knowledge known as modern medicine. Nonetheless, it is important for any profession to be critically self-reflective if it is to continue developing.
The whole disease care system is permeated with fear, for fear brings the patient to see the doctor and fear motivates the patient to stay in the system. As a consumer of health services, you must realize that every year medicine becomes less of a noble profession and more of a business. And every business must motivate the customer to buy their services. In medicine that motivation is typically fear – fear that you may have heart disease, cancer, or any number of horrible illnesses. What passes for patient information distributed by your local physician or hospital is often little more than a provocation to pick up the phone to set up an appointment because you may have one of the tell-tale danger signs of a dangerous disease. It is not uncommon for medical students to become anxious as well when first studying diseases, the symptom of which they suspect they may have. Similarly, when you peruse a long list of symptoms associated with vague illnesses such as yeast infection or chronic fatigue syndrome, almost everyone has some of them, making for brisk book sales. I am reminded of the sage words of Alexander Pope:
“A little learning is a dangerous thing. Drink deep or taste naught the Pierian Spring: there shallow draughts intoxicate the brain, and drinking largely sobers us again.”
It can be frightening to enter the medical system, particularly these days when the underlying agenda may have more to do with staying on schedule and corporate profits than what is in your best interests. I frequently meet patients who have been hastily misdiagnosed after a brief, fifteen-minute appointment and sent off for a battery of testing. Better to have a doctor spend the time to take a careful history, greatly narrowing the diagnostic possibilities and avoiding costly and invasive testing.
It is not only the patient who is fearful of the medical system. Doctors also live in fear of irate patients who might damage their reputation or report them to the local medical board whose censure will be recorded in a national registry. Worst of all is the fear of a medical malpractice suits. All of this fear feeds on itself, prompting physicians to order more tests to decrease their liability exposure. The unfortunate effects of this fear-driven medical system is most clearly seen in modern obstetrical practice where the C-section rate in some hands approaches thirty percent and where obstetricians pay astronomical malpractice premiums. We have forgotten that pregnancy and labor is a natural event, not a disease, and that 98% of all pregnancies will end successfully whether there is a doctor present or not?
And once you get into the system, it may not be so easy to get out. For example, the detailed imaging capabilities of MRI’s and CT scans, might pick up an abnormality that will require further studies and perhaps a biopsy – just to be sure. There are also a number of drugs that are routinely prescribed, such as antihypertensive or cholesterol-lowering drugs, with the expectation that you will take them for the rest of your life, and require ongoing management. Some psychoactive drugs, like anti-depressants and tranquilizers, once started are difficult to stop due to serious withdrawal reactions which often exacerbate the original problem. They alter the brain metabolism in such a way that it can take months to normalize once discontinued. If a person is prescribed a drug they can’t stop taking, they have been made dependant in a way that verges on addiction.
On the other side of the coin, there are people in need of medical care who avoid doctors for fear of losing control to the medical system, or who fear the pain of diagnostic tests, the expense, the vulnerability and the embarrassment of being sick. And we should never underestimate the power of denial to avoid an uncomfortable truth. Ironically, emergency rooms are full of people who out of fear rushed to the hospital for minor medical ailments, as well as people who out of fear waited too long.
From an evolutionary perspective fear is a primitive emotion that exists in the ancient, sub-cortical brain, far below the higher intellectual centers of the neo-cortex. Thus, decisions made on the basis of fear are seldom wise. At the same time deep healing occurs in a state of relaxation and safety, not anxiety. It is well established that chronic stress is a major contributor to physical disease. For example, three 10-year studies concluded that emotional stress was more predictive of death from cancer or cardiovascular disease than smoking; people who were unable to effectively manage their stress had 40% higher death rates than non-stressed individuals.
As an antidote to medically induced fear, I recommend a principle borrowed from the English law system: you are innocent until proven guilty. In the same way: you are healthy until proven otherwise. Certainly there is a place for reasonable screening tests, immunizations, and other preventative health measures. But we should never lose sight of the most important health measure of all which is to live well.
The bottom line: if you feel your doctor, dentist, lawyer, or professional politician is playing on your fears, by all means slow down, breathe and seek more information, perhaps a second opinion, and above all don’t rush into any big decisions. Take the time to temper your concerns with wisdom.