A lot of what I do as a primary care doctor is reassure patients that they’re normal. This isn’t as easy as it seems.
Many forces cause people to doubt themselves and their health. Since 1997, drug companies have been able to market their medications directly to consumers. Diseases have been created to fit their advertising schemes: Acid reflux. Social anxiety disorder. Pre-menstrual dysphoric disorder. Cholesterol marketed as a disease. Erectile dysfunction.
Better living through chemistry? Maybe.
The downside is that we’ve created a culture of consumers who expect manufactured remedies for almost anything that worries us. We are losing our self-efficacy.
During my residency, when I figured out that much of what doctors do is reinforce normalcy, I began to doubt myself.
Would this be a valid career?
More importantly, would I be “adding value” to patients and their lives?
Fortunately, the long training process removed most of the doubt. I began to see that helping people understand that there’s no one “normal,” that there’s in fact a wide range of normal, has intrinsic value. And that how that idea is conveyed, how it’s communicated, makes a lot of difference for people.
Moreover, helping people understand that for the most part we’re all within a range of normal, even when we don’t feel normal, is crucial. It’s crucial because if we chase after every abnormal sensation or feeling with medical testing, we not only threaten to break the bank, but we cause harm. By over testing we reinforce the doubts; we medicalize the complaints and give them a life of their own.
Here are some of my favorite examples–none serious, but in the right context of worry, very serious for any of us as a patient:
- Muscle Cramps: There really isn’t any good medical model for true muscle cramps. They tend to occur from high tension repetitive stress, like sports. But patients often come in and mention cramps, often that get worse at night. As a precaution, we’ll often check blood potassium and/or magnesium levels. In my experience, they’re always normal. If you can figure an action that’s causing the cramps and change it or stop it, then you’ve solved it. But it’s not easy. For some people, I think cramps are just part of normal life.
- Clicking/popping: A patient comes in and says, “My ______ (name it: knee, hip, shoulder, leg, etc) pops. And it worries me.” Does it hurt? No is usually the answer. Popping/clicking/cracking can occur almost anywhere in the body. We’re covered with synovial joints–basically knuckles that can be cracked–even in your chest or back. There’s no evidence that any of it causes anything. True knuckle cracking included.
- Gas: I love it when a patient is brave enough to admit they’re concerned about gas. It’s _______ (smelly, frequent, embarrassing). Well, let me tell you. This is normal. You may not want it to be. Your spouse/friend/neighbor may wish you didn’t have it, but it’s normal. Enjoy it. It’s part of life.
Have you ever had a discomfort/odd sensation for which you sought help from your doctor and were made to feel reassured without a lot of diagnostic fuss?