The worried well

Patients who over-research their ailments sometimes do more harm than good.

By Robert Burton, M.D.

Sep 27, 1999 | I am out walking in the Marin headlands, enjoying the first sunny day in weeks, when a health-club acquaintance, let's call him Carl, draws up alongside me. No hello, no superficial Marin greeting. Instead he launches directly into "What do you think is the best treatment for prostate cancer?" Without waiting for me to answer, he recites a litany of possible treatments. "Is it surgery, CAT scan-based radiation, brachytherapy or proton beam?" Carl is wearing hiking boots and cutoffs, and looking the well-tanned picture of health.

"Any particular reason for asking?" I say. Carl is directly in front of me, blocking my path. He hunches over and points to his mid-abdomen, about a foot above his prostate.

"I feel something different. Maybe an ache. It's hard to describe."

"Do you have a family doctor?"

"Already seen him. He says it's nothing. But, you know, he's just a GP. So, which treatment do you recommend?"

"Aren't you being a bit premature?" A single storm cloud gathers overhead.

"I've spent all morning online. The Johns Hopkins Web site says -- "

"Wouldn't it be better to wait until you've at least had a biopsy," I kid, hoping to defuse his anxiety with a little humor. No such luck.

"Yes. There's the needle biopsy, and the open biopsy, and the stereotactic-guided ... Any opinion?" he asks.

"Your doctor did the appropriate tests and said not to worry?"

"Uh-huh. But ..."

The sun dips behind the cloud. I want to follow.

I have known Carl for 10 years. I have nursed him through non-existent melanoma, bowel cancer, cardiac disease, fibromyalgia, you name the condition, Carl thinks he's had it. I like Carl. He is smart, humorous and well-read. But he is incredibly anxious and could try the patience of Job. In health-related matters, he is his own worst enemy and probably drives his doctors crazy.

He is not alone. When I was in medical school, we were taught that the majority of medical office visits were for reassurance of the "worried well." Their endless questions sometimes do more harm than good.

Anxiety over health seems to be increasing precisely at the time that technology is producing major medical advances. The two may be related. When there was negligible treatment available for most conditions, there was little value in worrying. Early detection wasn't relevant. Now, with the improved treatments, God forbid if that little ache is a warning sign as opposed to a fleeting nothing.

I, too, am a worrier. So was my father. As a pharmacist, he had an entire medicine cabinet filled with pills. Most were homeopathic and were there just in case something were to go wrong. I learned from a master.

So, what makes me different from Carl? Very little, except that my anxiety embarrasses me, and I try not to show it. I make jokes and try to disarm my doctor with self-deprecating humor. All well and good, except when something goes wrong, even theoretically. I get sweaty waiting for the results of my yearly routine blood work.

Joseph LeDoux, a prominent neuroscientist and author of "The Emotional Brain: The Mysterious Underpinnings of Emotional Life," has suggested that a single frightening episode can trigger a lifetime of fearful behavior, and that the behavior is not immediately accessible to conscious control. Once the response is laid down, it takes precedence over rational thought and is perpetuated through the formation of powerful neural connections. Any repetition can become a hard-to-break habit. Anxiety generates anxiety; the pathways build upon themselves, which is why, once the pattern is established, it is so difficult to break. I have tried everything -- deep breathing, meditation, positive thinking -- but still get dizzy when the lab results come back. I sneak a peak out of the corner of my eye, ready to be alarmed.

Next Page: Why patients should be more fatalistic

• View blog reactions