William Penn Life, 1969 (4. évfolyam, 1-12. szám)

1969-08-01 / 8-9. szám

soared. “I know it!” Jones thought. “The doctor is deeply worried about me. I must be in worse shape than I first thought.”

Thus, when the doctor finished his examination and optimistically announced, “Your blood pressure and your heart seem completely normal,” Jones wasn’t at all reassured. “The doctor just doesn’t want to scare me by telling me the truth,” he thought. “And he’s protecting himself by saying I seem all right instead of definitely telling me there’s nothing wrong.”

Jones became all the more concerned when the doctor added, “Just to make sure, we’d better have an x-ray and an electrocardiograph report.” “He certainly wouldn’t put me through all that,” concluded Jones, “unless he wanted to verify what he already thinks—that my heart’s in a bad way.”

Finally, all laboratory studies were completed and the data compiled by which the doctor arrived at his diagnosis. “Well,” he said, as Jones, obviously anxious, took a seat in the office, “we didn’t detect a single thing wrong with you, and all the laboratory findings are negative.”

“Negative!” Jones thought. “That’s an inconclusive term.” He then told the doctor that he was sure something was wrong with him. In fact, that was why he came to see him in the first place.

The doctor replied, “Maybe you’ve been working too hard or had some other cause to worry, or some additional irritations. Why not get a rest from your business for a while? Take a leisurely, restful vacation.”

This advice quickly confirmed one of Jones’ worst fears. “I thought he’d tell me to stop working,” he said to himself. “He’s just letting me down easy. What he means is that if I’m not careful, I’m likely to experience a severe heart attack at any time.”

And so, instead of being reassured as he should have been, that he was well, Jones couldn’t erase from his mind the earlier look of anxiety on the doctor’s face. He went home, still convinced that he had a bad heart condition and that the doctor was trying to keep the truth from him.

During the next several weeks, Jones visited three other doctors, and all of them, after recommending laboratory tests, confirmed the earlier diagnosis, “There’s nothing wrong with your heart.” But there has to be something wrong, reasoned Jones. The pain in his chest was still there. Besides, new symptoms appeared. Not being convinced, he gave up all his old recreational activities—fishing, hunting, golf, and even gardening. “My heart just won’t take it,” he told his friends.

Finally Jones took a long trip to be examined by a top specialist in a famous clinic. This specialist listened attentively to Jones’ history, asked him many questions, studied the medical reports that he had brought, and said, “Mr. Jones, I’m not going to recommend any more tests. These reports convince me that there’s nothing radically wrong with your heart or any other organ. And from what you’ve told me, I rather strongly suspect that your symptoms are functional—that is, they are caused mainly by emotional or mental processes associated with your fear of heart trouble.”

Jones, who felt that he made the long trip at the expense of considerable strain on his heart, arose from his chair abruptly and said, “Doctor, I

didn’t come all the way here to have you tell me there’s nothing wrong with me. I know pains when I feel them, and, believe me, I’ve got plenty of them. I’ve got heart trouble, I know it. And one of these days—so help me!—I’ll find a doctor who’ll find it and treat it.”

We’ll not find it profitable to follow Jones’ history further, hoping we have made our point. Suffice it to say that he’s the lamentable victim of one form of iatrogenic disease. His symptoms are, of course, quite real and equally distressing. But they do not result from any organic pathology. Rather, they result solely from the anxiety built up around his fear of a heart attack and perhaps sudden death as experienced by his friend.

An iatrogenic disease is not always concerned solely with the heart. It may stem from anxiety about any organ of the body, or from a general fear of cancer, mental disease or other illnesses happening to women as well as men.

However, according to Today’s Health, a publication of the American Medical Association, the heart is the organ most frequently involved. “The manifestations of iatrogenic heart disease are those commonly produced by anxiety. Palpitation, fatigability, breathelessness and precordial pain are

symptoms and are perfectly suited to verify the thought of heart disease in the mind of the patient.”

It is well to point out that anxiety resulting from such symptoms often tends to perpetuate itself. “The very symptoms continue to suggest cardiac abnormality to the patient and thus maintain his fears.” “There is no mortality problem but the morbidity may be greater than in the average case of organic heart disease.”

Fortunately, by psychotherapeutic means, iatrogenic disease can be treated and cured, but it is preferable to prevent it in the first place. According to Dr. Harry B. Weinberg, it is “potentially 100 percent preventable.”

Modern doctors are increasingly recognizing the role they play in prevention and are learning to exercise care so as not to do or to say things which might foster iatrogenic disease. But patients have a responsibility for prevention—the responsibility of making sure that they really understand their doctors.

What are some of the common mistakes to be avoided? We’ve learned most of them by analyzing one case. So that they may be more easily remembered let’s list them:

Avoid self-diagnosis.

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