Worrying the well

I have just watched an excellent and important programme on BBC TV (BBC2, 12 August 2015: Dr Michael Mosley: Are Health Tests Really a Good Idea?), which you can catch up with on BBC i-Player.  As its title indicates, it looked in depth at the value of some of the many tests well people undergo, and queried how far many of these were necessary.  Importantly, in view of the enormous costs of providing health care for an increasingly aging population, it asked whether the vast amount of money allocated to these tests, which are overwhelmingly directed at the still well, would better be spent on treating the already ill.  The conclusion by two very eminent physicians, one from the United States and the other from Britain, summed it all up beautifully.  Surely, they said, it is better to direct resources at where help is needed, which is when a condition has actually revealed itself, and not spend so much on recommending tests for the well whose results are often uncertain, if not downright misleading.  The case of mammograms, in particular, was examined here.  It was pointed out that they often lead to needless, harmful and unnecessary interventions (a figure of 9 out of 10 mis-diagnoses was given).

This is when I heard the very telling and hard-hitting phrase, which underlines exactly what I think is the wrong direction in which the machinery of health is heading, and that is that “we are worrying the well”.  Once we are given the slightest indication that there is a slight query about any test result, none of us will be able to forget this, and it will continue to haunt us.  As I said in my book, The Keepers of the Soul, “One of the many areas to be re-assessed is the Western reliance on statistics. The trouble with statistics is that they are illusory.  They appear to be based on scientific fact, and offer scientific validity, but they have no meaning whatsoever in the individual case.  If a test is said to offer a 60% probability of establishing that a person is likely to suffer a heart-attack, am I in the 60% category of the sick or in the 40% category of the well?  No-one can tell me this, but human nature being as it is, all 100% of us are unlikely to sleep easily at night with such a statistic hovering over our heads.  And yet we may never fall ill.”

And again, “Once in hospital hands, we often find they never let us go, for one test or another, imperfect as all tests must be, may surprisingly often yield a slightly ambiguous result which demands a different test or a further check-up later on, leaving us forever waiting for what we anticipate may be a dreaded result, as though shackled to a permanent pathological prognosis.  This is a depressingly frequent occurrence, for no doctor appears to dare sign us off for fear of future repercussions.”

I will leave it to the lovely British doctor in the programme to confirm what I so deeply believe in.  “We are frightening well people”, she said.  And what I particularly liked was her conclusion.  “We are seeking technological solutions to existential solutions.  We all have to get old, we all have to die, we all have to lose people we love.  We are devoting resources to worrying the well”.   It is rare for anybody in what I call this medicalized society, particularly a medical practitioner, to state this so clearly and so baldly.  Modern society is in danger of adopting a mind-set which devotes too much time to searching for pathological symptoms instead of concentrating upon nurturing the valuable aspects of our life, and accepting the natural course of life, which may or may not include illness, but will inevitably conclude in death.