In elementary school, we read an essay named ‘The Man Who Was a Hospital’ by Jerome K. Jerome. This is a humorous essay in which the writer describes his misadventure in a humorous way. He says that once, he was reading a liver pill circular when he suspected that his liver was out of order. He went to the British Museum Library to study the details of liver disease. He studied the symptoms, and he came to know that he was suffering from that disease. He studied further one or two diseases, and he was surprised to know that he had those all. Thinking the same thing, he began to read each and every disease alphabetically.
He came to conclude that he had all diseases except housemaid-kneed disease (pre-patellar bursitis), and he was quite disappointed by this fact. Rather than being worried, he began to think of himself as a valuable asset for the medical students. He thought that he must be a hospital in himself, and the medical students would have to go around him and take their diplomas. He then went to a doctor and told him the whole situation. After examining him, the doctor assured him there was nothing to be concerned about. He was well and in good shape. He requested him to leave after giving him the prescription. After that, he took the prescription to the chemist and gave it to him. After reading the prescription and returning it to him, the chemist said he was unable to fulfill it. He was informed by the chemist that the prescribed items were not kept. The prescription was to take 11 pounds of steak every 6 hours, walk 10 kilometers every morning, and go to bed at eleven o’clock every night. Moreover, to avoid overcrowding your mind with concepts you can’t comprehend.
At that time, I just laughed at that essay, and now, when I am a doctor myself, I know about hypochondria; I can understand what the thought process of the writer was and the kind of message he wanted to convey. In our country, after the advancement of technology and the arrival of easy access to the internet and Google for everyone via smartphones, there has been a marked increase in hypochondria. Moreover, there are a lot of videos on YouTube in which people who do not even belong to medicine keep on describing different diseases, their symptoms, and cures. The majority of our people keep on watching these videos all day and develop a lot of anxiety about the chances of developing different diseases. Whenever they see a slight symptom in their family and friends, they start diagnosing and giving them treatment options without any solid knowledge. This is very common in almost all of the subcontinent.
Our people when they go for the routine medical checkup, get disappointed when all of their blood workup comes normal. They think that their hard-earned money has gone to waste if the general physician doesn’t prescribe them any medication. When they would be leaving the doctor’s room, they would just say, ”Doctor, please prescribe me some multivitamins for my weakness.” Our people eat multivitamins like candies instead of improving their diet and sedentary lifestyle.
However, I have noticed that the people belonging to medicine are the ones who are suffering from hypochondria more than even the common population. Due to studying a lot of medicine all their lives, subconsciously they develop the fear of getting these diseases themselves and among their family members. Even the slightest ailment makes them uneasy, and they never hesitate to get every investigation done from head to toe. Sometimes, out of this fear, the doctors start getting medical checkups and unnecessary investigations of their family members and then start getting worried over each and every small deviation from normality and even start getting treatment for those things that don’t even matter. A lot of my friends are worried over slight dyslipidemia or the prediabetes of their parents. Instead of changing their habits or lifestyle modification, they are giving them statins and metformin.
We are the champions in getting unnecessary investigations and getting medication for every small problem. Recently, I developed a slight cough and night sweats along with feeling a little cold, and it continued for a month. The weather is changing, and there is a rise in viral influenza, but the symptoms are not settling even after one month. I went to see the best pulmonologist in my hospital, and he never bothered to leave his chair and just auscultate the chest. He said to me ” “Look, Daman, do you have any tuberculosis exposure?” I denied. He said, “Are you vaccinated for BCG?” I nodded in agreement. But he was persistent that these were the symptoms of tuberculosis. He ordered a CT chest, TB gold, ESR, and routine blood. All of them came out to be normal. In the end, he said maybe it’s just viral and referred me to ENT.
In the following week, I developed parotitis and conjunctivitis as well. I started having a high-grade fever and sore throat. The ENT physician was the first one to examine my throat, and he said it was nothing but follicular tonsillitis. He prescribed me antibiotics, but in the end, he also started relating conjunctivitis and parotitis and ordered a complete autoimmune workup, thinking of dry eyes and parotitis together. All of that came out to be normal, and it was actually a bacterial throat infection superimposed over a viral infection. But the thought of having tuberculosis and an autoimmune disorder gave me nightmares for days.
Yesterday, our hospital pharmacist, who is just 50 years old and had a positive family history of prostate cancer in his father, diagnosed at the age of 70, came to us with a PSA of 5. He told us that he has been monitoring his PSA over the past ten years, and it has started rising. He had taken a one-month course of antibiotics just with the thought of treating his drug-resistant urinary tract infection. I don’t know why he had the thought of developing prostate cancer at the age of 40. Still, he was persistent in getting an MRI prostate and even a TRUS-guided biopsy instead of just surveillance.
One of my friends who is in ophthalmology was suggesting starting cyclosporine ophthalmic drops to another friend just with a thought of keratitis because her viral conjunctivitis was prolonged.
Recently, I admitted a breast cancer patient on Sunday with a lower respiratory tract infection. She was on chemotherapy and had all of her staging workup done last month. Her disease was stable, and the scans were fine. When I saw her in the ER, she just had one spike of fever and had a mild wheeze on chest auscultation. All of her infection markers were normal except CRP, which was slightly raised. On the excessive insistence of her attendant, I admitted her and advised her to take antibiotics and nebulizations to make her better. When I called my attending to inform him about her condition, he advised me to get a chest CT done ASAP just to rule out disease progression. I was so frustrated that I told him CT scans were being done for emergency cases only on Sundays just to save the 30,000 PKR of the patient.
A lot of consultants in oncology keep on doing excessive screening for the patients just on a small suspicion of small symptoms. They forget about the cost, inflation, and condition of the health care system in Pakistan. They keep on ordering CT scans without the thought of unnecessary radiation exposure.
In this way, the population that actually needs treatment and lacks resources gets neglected, and there is a lot of burden on our health care system that is already crumbling.
There is a concept of “manifestation” in the universe as well. To manifest something means to think about it often and with focus until you receive it. It’s the idea that if you want something, you can mentally attend to it and will it into existence. One of my friends who works in gynecology recently got married, and every time she saw a patient with an ectopic pregnancy, she became extremely anxious and was always worried about getting an ectopic pregnancy herself. In the end, she developed an ectopic pregnancy, underwent laparotomy, and had a huge blood loss. All of us had to donate blood just to save her.
We counsel our oncology patients a lot to stay positive because even after getting the best possible treatments, they always think that their disease is going to progress soon. And sometimes, it does happen in patients who think like that.
Our people take a lot of opinions from strangers about their diseases and discuss every minute detail about their disease with their neighbors and extended family. Half of my day is wasted on counseling the patients who come from the radiation waiting area and come to me to discuss why they aren’t getting the same treatment as the person sitting next to them in that area. I have to counsel each and every patient on just this simple fact: that each patient has a different kind and stage of disease and is treated differently according to their condition and type of tumor. I sometimes feel so frustrated by this extra headache that there are days when I think of leaving oncology.
Maybe because of our good theoretical knowledge, we think about every possibility, but the art of clinical examination is becoming obsolete day by day. In older days, experienced physicians avoided unnecessary investigations and were a lot more confident in their clinical skills. These days, physicians don’t even use stethoscopes around their necks. Sometimes, I laugh at the thought that we just use that stethoscope as an excuse to get entry from the gate reserved for medical staff. And I always laugh at the possibility of gaining entry into the hospital by anyone having a stethoscope around their neck from the staff gate.
Damane Zehra is a radiation oncology resident in Pakistan.
