A new syndrome is on the rise, and I call it healthcare PTSD (post-traumatic stress disorder). I\u2019m seeing more and more examples of it among my new patients and it\u2019s got me worried. Why? Patients are coming to me with symptoms of depression\/anxiety and\/or obsessive thinking triggered by having entered the health care system. Our US health care system, allegedly the finest in the world.<\/p>\n\n\n\n
It\u2019s best if I relate a typical case.<\/p>\n\n\n\n
Judy, a smart women in her late 20s with a fine new job and solid relationship, had always had digestive problems. Unpredictable diarrhea or constipation, bloating, heartburn, some food intolerances. In college she\u2019d been told it was irritable bowel syndrome (IBS), but Judy was never happy with that diagnosis, even though she\u2019d had the same symptoms for years. Armed with new employee health insurance, she wanted more information about what was going on in her belly. So she signed up with one of the best known medical centers in Chicago and waited for her appointment.<\/p>\n\n\n\n
When she arrived, she told me, the place felt like a factory. A clearly rushed doctor (whom she would never see again) says he\u2019s her \u201cprimary,\u201d listens for a few minutes, and then tells Judy he needs to rule out ulcerative colitis, Crohn\u2019s disease, and, although it\u2019s rare, cancer, and refers her to a gastroenterologist. When Judy mentions she has occasional tingling in her hands, he looks worried and says \u201cwe should also rule out multiple sclerosis (MS). Let\u2019s get a thorough neuro evaluation as well.\u201d<\/p>\n\n\n\n
Judy thinks about the possibility of cancer or MS constantly,<\/strong> but a few weeks later the gastroenterologist she sees is dismissive. \u201cIt\u2019s just irritable bowel. Calm down. Your primary wants me to rule out cancer, which I guarantee you don\u2019t have, but we\u2019ll schedule a colonoscopy anyway. Heartburn? Let\u2019s do a gastroscopy while you\u2019re in there.\u201d<\/p>\n\n\n\n Remember that each appointment requires scheduling time off work, parking fees, nervous time in the waiting room, still more nervous time wondering if the doctor will listen, and wondering how tests will turn out.<\/p>\n\n\n\n Judy follows all the instructions for her tests. She schedules more time off work to actually have them, and her boss gives her the evil eye when she finds out about yet another doctor appointment. Judy feels a vaguely tight sensation in her chest and now has near-constant headaches and aching muscles. After the procedures (results: completely normal), she tells the gastroenterologist about these new symptoms.<\/p>\n\n\n\n \u201cNot my area,\u201d he says. \u201cBut let\u2019s check out that heart. Since you\u2019re getting the neuro eval for your tingling, she can look into this headache of yours. We\u2019ll add a cardiology consult, and rheumatology too to make sure the muscle pains aren\u2019t something autoimmune.\u201d<\/p>\n\n\n\n At this point, Judy tells me, she\u2019s spending her nights on the internet reading about every symptom she\u2019s feeling and what it could mean. <\/strong><\/p>\n\n\n\n After five months, Judy had seen her primary care physician just once (when she returned for a follow-up, he\u2019d left and she was assigned to someone new), a gastroenterologist, neurologist, cardiologist, and rheumatologist. She\u2019d undergone many blood tests–often the same tests repeatedly–a gastroscopy, colonoscopy, electrocardiogram, stress test, pulmonary function test, sleep study, and MRI of her brain. She\u2019d had a total of 10 visits, averaging three hours each or more, and as a result her job was now in danger. She worried what would happen if she were fired and lost her insurance.<\/p>\n\n\n\n All Judy\u2019s blood tests, x rays, and procedures were negative, except for one, a screening test for the autoimmune disorder lupus erythematosus (though she didn\u2019t have a single symptom of this condition), and even this was ruled out when the confirmatory test came back negative. Nevertheless, the young doctor in the rheumatology department said, \u201cSince it\u2019s the only positive test we\u2019ve got, we\u2019ll start you on this med for lupus and see how it goes.\u201d<\/p>\n\n\n\n Judy read the side effects of the drug online, read about lupus, plunged into major stress, and started sleeping poorly and losing weight. Everything in her life seemed to be crashing around her and all she could think about was whether or not she had some fatal illness that the doctors couldn\u2019t diagnose or weren\u2019t telling her about.<\/p>\n\n\n\n The stress of Judy\u2019s encounter with the health care system had produced symptoms of post traumatic stress disorder (PTSD). And it\u2019s not uncommon. Believe me, this health tip is based on actual patients and their experiences. <\/strong><\/p>\n\n\n\n Helping Judy get her life back on track was straightforward. Once we\u2019d gone over all the lab tests again (it\u2019s not uncommon for patients to drag a wheeled suitcase filled with lab reports into the exam room) and reconfirmed that everything was negative, we tried to convey these facts: I can hear you asking now: don\u2019t these investigations ever turn up actual disease, Dr E? Yes, occasionally they do, but in a tiny minority of people who move through the system.<\/p>\n\n\n\n When patients who\u2019ve been through these healthcare wars come to see us, we emphasize first that no more testing is necessary (for many patients there\u2019s not a lot left to test) and that serious illness has long been thoroughly ruled out. We underscore the necessity of stress reduction, often including short-term counseling, and getting the body functioning smoothly again using gentle therapies like healthful nutrition, movement, supplements and herbs to replace prescription drugs, acupuncture, chiropractic, homeopathy, and the like.<\/p>\n\n\n\n
\u2022 Messages from your body<\/strong> Most symptoms, especially longstanding ones that don\u2019t change much, are not signs of disease. They\u2019re the result of you being aware of minor, temporary glitches or dysfunctions in your body that actually are trying to communicate a message to you. In other words, most headaches aren\u2019t brain tumors–they\u2019re tense muscles in your neck. Diarrhea\/constipation\/bloating usually comes from stress. And so forth. Doctors call these \u201cfunctional symptoms.\u201d I call them messages from your body asking for change.
\u2022 Doctors are trained to look for disease<\/strong> rather than think much about functional symptoms. To ferret out disease, they order tests (parenthetically, the cash-cow of the health care system). Functional symptoms–because they aren\u2019t disease–never give positive test results.
\u2022 If a doctor in one specialty can\u2019t generate any positive test results,<\/strong> instead of telling you, like the villagers down the road from Dracula\u2019s castle, \u201cGet out of here before it\u2019s too late!\u201d she\u2019ll generally check your list of symptoms outside her specialty and refer you to another specialist who has his own catalogue of tests and procedures waiting for you.
\u2022 All this would make any average person a nervous wreck.<\/strong> And because functional symptoms are exacerbated by stress, things seem to get worse and you become more even more convinced you have something.
\u2022 The risk of positive tests<\/strong> If along the way, any of your tests comes back even minimally positive, unconsciously the doctor is delighted because he feels he\u2019s made a diagnosis. And once there\u2019s a name for your alleged condition, he can write you a\u2026 prescription.
\u2022 But you won\u2019t improve because the prescription is inappropriate.<\/strong> You have functional symptoms, remember? Not a disease. And taking the drug will likely make you feel worse from the side effects.<\/p>\n\n\n\n