The Worried
Well
An interesting phenomenon every
primary care physician can attest to is the number of patients on their schedule
who consist of the “worried well” or otherwise healthy people who aren’t that
ill but come to the doctor for very minor complaints. Ailments like the common
cold, eczema, constipation, or a small scratch; all very minor afflictions not
requiring treatment from a medical professional drive some people to take time
out of their schedule to pay us a visit. At times these visits are annoying, as
they can be time-consuming for something very minor, but at times they are
uplifting, for example reassuring someone with a headache that it is likely due
to dehydration and not to a brain tumor. In the developed world, many of these
patients are retired and elderly, with little to no copay so a visit to the
doctor every now and then fits right into their routine. Then you have the
highly educated patients who spend a bit too much time on Google and think they
have a rare disease they read about that explains their myriad of symptoms that
is usually attributable to stress, poor diet, lack of exercise or sleep. Then
there are the first-time parents who bring their child in for every sniffle,
convinced they have pneumonia and need antibiotics. All of these patients are a
regular and welcome part of my practice. Part of the reason I switched careers
from Emergency to Family Medicine was to have more of this type of patient; to
be able to give people good news (“It’s just a cold, you’re going to be fine in
a week!”) instead of the all too-often tragic news I had to give to families of
the trauma patients I saw in the ED.
For many years, I thought the
phenomenon of worried well only affected those living in developed nations with
regular access to a car and the internet, but after this last week working in
Honduras I have noted this is not just a phenomenon in the developed world.
Having worked internationally in several different settings from Latin America
to Sub-Saharan Africa and Southeast Asia, I can attest to the variety of severe
diseases that preferentially affect the rural poor such as tuberculosis,
malaria, and malnutrition. Additionally, a variety of chronic diseases such as
hypertension, diabetes, and coronary artery disease are affecting developing
nations thanks to the trickle-down bad habits of developed nations such as
processed foods, cigarettes, and inactivity. These are fast become the norm in
many societies that once lived more traditional and active lifestyles.
I think most physicians from
developed nations who work internationally in more impoverished nations have
some sort of expectation of advanced disease and exotic illnesses as compared to
their usual patient population. I know I have been guilty of this assumption
many times while volunteering abroad. Yet the more short medical volunteer trips
I go on, the more I notice the phenomenon of the “worried well” is not just
confined to wealthier countries. A volunteer doctor in a refugee hospital
elegantly describes this sentiment too in the quote
below:
“I could hardly believe how
many people waited in clinic all day long because of colds, headaches, or other
minor ailments that my grandmother could have treated. They came in for a
variety of reasons, such as a need for reassurance, validation of their illness,
or a “laying on of hands.” No matter where you practice, the “worried well” …
are part of your everyday routine.”
-Dr. Timothy Holtz
A Year in Little Lhasa: One
Year in Dharamsala with the Tibetans in Exile
What I noted in Honduras was
that many patients complained of cough and cold but didn’t seem to have any
symptoms. When I would tell them they were fine they suddenly would also
complain of a headache or stomach pain and request medications. Sometimes they
flat out told me they just wanted some antibiotics or vitamins, or just wanted
me to check their children to make sure they “looked alright.” Again, I was more
than happy to oblige-well child checks are a regular part of my practice, but I
would say the vast majority of patients I saw in Honduras were healthier than my
patients in Vallejo! There are obvious other socioeconomic and educational
concerns, and they cycle of poverty is very much at play in rural Honduras, but
based on what I witnessed last week, most of the adults and children appeared to
be in very good health. This is a very good, but surprising thing to me, and
granted was just a very small glimpse in time of a very small portion of
Honduras population. Many people, including the project leaders, told us how
much the health of the local villagers had improved since project ENLACE started
coming.
I am reassured to hear this
good news, and hope that our future efforts will continue to improve the health
of the people in Taulabe to the point where volunteer doctors are no longer
needed. I am also amazed by the common human need we all have to be touched,
validated, and told that we are okay just as we are.
Dr. Jessica de
Jarnette
PGY-3 Kaiser Napa-Solano Family
Medicine
