Doctored to Death?

What is a Doctor Junkie?

A commenter on the Medical Mafia post brought up the subject of doctor-junkies, and readers seemed fascinated by the idea.

Yes, doctor-junkies are real and they are everywhere!

Just as Doctorphobia is hazardous to your health, Doctorphilia can be equally disastrous.

Any regular reader of AskAnMD is aware that while MDs are useful, we can also be dangerous. An addiction to doctor-visiting will lead to lots of risky tests and medicines you don't need. Too much doctoring can take you to an early grave and make you miserable on your way there.

Who are these Doctor-Junkies?

Doctor-Junkie: (n) -a person who believes that every uncomfortable or unusual physical sensation must be evaluated by a doctor.

While most hypochondriacs are doctor-junkies, not all junkies are hypochondriacs. Some doctor-junkies aren't paranoid they have a horrible illness, but just feel every little thing must be "checked out."

Dangerous Doctorphilia is often an inherited condition. Doctor-junkies start out as those kids whose parents rush them to a doctor every time they sneeze or scrape their knee:

Once a mother brought her child to Doctor D's ER because the toddler had made an especially loud sigh. "A sigh?" I asked. "Yes, like this" and she made a sighing sound "so I just wanted you to check his lungs." Doctor D assured mom that we all sigh on a regular basis, but perhaps this sigh was louder because of her child's frustration that he had a mother with nothing better to do than gauge the volume of his sighs. She demanded a Chest X-ray just to make sure. Then Doctor D let out a loud sigh of his own.

You would think after a childhood spent in ER and clinic waiting rooms that someone would want to escape the world of needles and medicines, but the junkie is hooked by the time they reach adulthood. Any runny nose or sore muscle and the doctor-junkie gets that overpowering urge to visit somebody in a white coat quick. The doctor-junkie isn't satisfied with just an exam and reassurance, "No doc, I've been waiting a long time to see you so give me the good stuff—lab tests, X-rays, and lots of pills!"

To the doctor-junkie no symptom is too mild or too brief: every physical discomfort needs blood work and prescription medicine ASAP. If you doctor's office is on lunch break then junkies call an ambulance for that mild sense of nausea!

In addition to wasting billions of dollars, all those visits likely shorten the lives of the junkies. Radiation from imaging studies leads to cancers. Lab studies eventually uncover benign abnormalities that junkies need fixed. Junkies get some really nasty side effects from meds, because they've often been prescribed every medicine in the pharmacy.

Rather than forcing the junkie at rock bottom to change his ways, being harmed by healthcare has the opposite effect: a doctor-junkie who is sick from over-doctoring feels the compulsive need for more and more and more.

Who is to blame for this epidemic of Doctorphilia?

Doctors!

Yup, it's us. We have the stuff that junkies crave, and docs give out unnecessary care like candy till we get everybody hooked.

Why shouldn't we? Docs get paid to see people whether they are really sick or not. A proper exam followed by educating a concerned patient is difficult and time-consuming, while ordering tests and writing prescriptions is just so quick and easy. Doing unnecessary care and writing unnecessary prescriptions keeps patients happy with us because they feel they are getting something done.

Plus, it's nice to feel needed.

I know a doctor who shall remain nameless that gives antibiotics to every single person with a runny nose. Now almost all runny noses are caused by mild viruses that cannot be cured by any medicine. Dr. Zpack gives everybody a useless antibiotic and they all assume that the medicine worked when the symptoms resolve on their own. His patients are apparently unaware that human beings have immune systems. Dr. Zpack's junkie patients love him because he always "cures" their infection, and it's good business for him because half his visits are simple colds he can easily "fix" with one prescription. When Dr. Zpack's office is closed his patients panic and rush to the ER at the first cough. He's a nice old doc, but who knows how many superbugs and dangerous reactions have originated with Dr. Zpack's prescription pad?

The fact that doctors give out unnecessary care immediately legitimizes it. Patients accept that it must be safe and necessary if doctors order it. Some patients casually dabble in being over-doctored, but some susceptible patients fall over the edge into full-fledged addiction.

The Addiction Gets Ugly:

It's a win-win situation for the dealer and the junkie until something goes wrong: The junkie gets too demanding or overdoses on unnecessary care resulting in an iatrogenic injury. Then Dr. Dealer freaks out and cuts off the junkie cold turkey.

Doctor D has seen it too many times: panicked patients in withdrawal from over-doctoring pitching fits in the ER that they have to wait an hour to be seen for their runny nose.

Recovery:

Coming to Doctor D's office (or his blog) is like detox for doctor-junkies. Appropriate medical care is often a shock to the doctor-junkie's system. Doctor D has to explain to recovering junkies that the human body is actually capable of healing itself. Who knew?

Fortunately Doctor D has a 12 step program for the Doctor-Junkie epidemic. Tune in next week for my prescription for curing the over-doctored!

What do you think? Have you or loved one ever suffered from Dangerous Doctorphilia? How did you recover? Do you blame MDs for this problem?

Did you miss Doctor D? Where were you when you first heard the word iatrogenic? What other irreverent medical topics should this blog tackle?

As always, Doctor D loves to hear your thoughts and stories in the comments!

Take The Bitter Pill? (Drug Side Effects)

From a reader:

"I am so tired of taking medications that seem to cause more problems than my diagnosed disease."

This is one of the trickiest problems in doctoring: all medicines have side effects. Doctors treat diseases, but we unintentionally cause a lot of suffering with our treatments.

Some medicines cause frequent side effects. Some medicines cause them only occasionally. Some patients very rarely get side effects. Some people seem to get a side effect from everything they take. Any one person's reaction to any one medicine is impossible to predict. It gets pretty complicated.

It's important to understand that having a side effect doesn't mean it was a "bad medicine." It may work great for lots of other people. You should also realize that a bad side effect doesn't necessarily mean you had an incompetent doctor. Doctor D can't count how many patients have told him, "I'm never going back to Dr. SoAndSo, because he gave me a prescription for a poison. It made me feel terrible." (Patients have probably said this about Doctor D too.) The doctor who diagnosed you and gave the medicine is often in the best position to help you approach the problem of side effects.

In the end, only you can decide if it is worth taking any particular medicine, but your doctor can help you understand the pros and cons of any medicine or treatment.

A few common situations involving medicines:

• Dangerous Disease, Few Symptoms: Some diseases like Hypertension cause almost no symptoms until it is too late. Lots of people stop blood pressure medicine for mild side effects just because they just cannot feel the pressure destroying their arteries. Low-symptom diseases like Hypertension, Type II Diabetes, and High Cholesterol kill millions even though we have lots of great medicines. People have a hard time taking medicine when they don't feel sick. If you have medicine side effects with one of the "silent killers" you really need to talk to your doctor about switching medicines. Going without any treatment is a bad idea.

• Benign Disease, Miserable Symptoms: A lot of conditions from the Common Cold to Fibromyalgia never kill anyone, but they can make you feel horrible. The symptoms are the disease and therefore if you can handle the disease better than the medicine the choice is obvious. Just be sure your doctor agrees you have a benign condition before making this decision.

• Bad Disease, Bad Medicine: This is always a difficult place to be. A horrible disease that is treated with medicines that make most people miserable. Many cancers fall into this category. Your doctor can help you understand the probable risks of the disease as well as the expected side effects of the medicine, but remember the decision is yours.

• Mixed Diseases: Some diseases cause some difficult symptoms now and often vary in the amount of long-term damage they cause. Rheumatoid Arthritis is an example of such a condition. Treatments are aimed at current symptoms, at long-term damage, or both. Decisions about medicines in such conditions are never as clear cut as the other diseases. If you have trouble tolerating a medicine, you should ask your doctor if stopping it would have any long-term ramifications.

All these decisions belong to you, but doctors are useful for educating you. If a medicine makes you miserable ask you doctor, ""I'd love to stop this med because of side effects, what might I risk by doing this? Are there other medicines that I could try?"

Have you ever quit a treatment that was working because of side effects? Was your doctor helpful in your decision-making process? Doctor D would love to hear your stories.