Memo From The Editor

Worried well

Marianne Dekker Mattera

Several days ago, I got a couple of letters from readers commenting on an article we ran in our November 8 issue called "They're not sick; they need a doctor; you can cope." You'll be able to read the letters themselves in an upcoming issue, but they hit a chord with me and I just had to discuss their bottom-line message here.

That message was basically that "the worried well" have no right to be pestering doctors and that they wouldn't be doing so if they were paying for their own care at each visit, instead of paying a small copay under a managed care plan.

I've got to tell you that I firmly believe that no one really wants to go to see you.

In the first place, it's not easy to see a doctor. It can take days just to get through to the office staff to make an appointment. You have to time the phone call to the office just right or you'll get the answering service telling you that (a) they're not in today, (b) they're not in until 11:00, (c) they're at lunch, call back after 1:30, or (d) they've gone home for the day. The patient who's made the call on his 10-minute break, may not have another chance to get through.

Once you do get through, you face all the joys of being put on hold, being given a date well into the future, or having to totally rearrange your schedule and, often, that of your employer and your entire family for the privilege of being squeezed into the doctor's schedule.

Then you get to the office, sign in, and wait. You wait in the waiting room sometimes for an hour or more past the scheduled appointment time. Then you wait some more in the exam room. Then, if you're lucky, you get 10 minutes with the doctor, who sends you elsewhere for lab or other tests.

To get those tests done, you may go through the same process you had to go through to get in to see the doctor. At the very least, you have to take more time off from work.

Then there's the follow-up on the lab work, which often means another visit with the physician. All the while, you're juggling all the other responsibilities of your life, fitting things in, rearranging lives.

And you do all this feeling lousy.

Whether you're feeling lousy because of some easily identifiable illness or because anxiety makes you one of what medicine has come to call "the worried well," you still feel lousy.

Doctors are supposed to want to help people who feel lousy—to want to heal the sick, no matter what's making them sick. You're not supposed to resent them for taking up your time with problems that are not easily diagnosed or easily remedied. Even if there are no somatic causes for a patient's distress, you have an obligation to ease his pain.

Do you have to like these patients? No, but you mustn't dismiss them, resent them, or ridicule them, either.

Patients pay a considerable price—at the very least in time (theirs is worth something, too, you know) and effort—to get in to see you. They do it because they feel they need to see you. Not because they want to see you.

We gave you some tips in that November article on how to help your anxious patients without becoming too anxious yourself. Now, I beg you, treat these worried patients as you do your other patients. Treat them well.

 

Marianne Mattera. Memo from the Editor : Worried well. Medical Economics Dec. 9, 2002;79:9.