One late-night Flomax commercial can send you into a cycle of anxiety: If urinating is easier without Flomax, then you think you need to get tested for prostate cancer.
I'm a hypochondriac, and I'm also a healthcare executive with insight into how the US healthcare system works and doesn't work, which may be why I focus so much on health.
People like me are often ignored by family, friends, and many doctors. Hypochondria is overlooked in the mental health field, tucked under the umbrella, broader category of generalized anxiety disorder. Even in a post-COVID era where mental health is front and center, hypochondria (also known as illness anxiety disorder) has yet to even recede to the sidelines. Its ripple effects demand our collective attention.
Hypochondriacs place a huge burden on the healthcare system. The condition, which involves an obsession with the fear of serious illness and death, leads to repeated and unnecessary medical tests and appointments. It is estimated that it costs the healthcare system hundreds of billions of dollars per year.
Insureds (both individual policyholders and businesses that provide benefits to their employees) are feeling the financial impact of this disruption on costs, with overutilization ultimately showing up as higher copays and premiums for everyone, resulting in huge inequities for average people.
A comprehensive approach to hypochondriasis
Frontline health care workers must act in service of both their patients and the health care system as a whole in the face of rapidly declining costs and resources. And in an age of burnout, they must protect their own competence (and capabilities). Emergency room physicians are the first line of defense to keep people like me from putting unnecessary strain on the health care system. They must have a trained eye to spot hypochondria, a gentle touch to ease the death-dealing fears of those who suffer from it, and a steely resolve to refuse unnecessary treatment.
Hypochondriacs can say the names of emergency department staff as easily as they can say the names of their own children, but primary care also has a vital frontline role. Hypochondriacs, as a group, see primary care clinicians much more frequently than the average person. This group knows who and what we are and is in the best position to influence our journey.
If a hypochondriac does not have symptoms but is seeking treatment, and medical professionals knowingly or unwittingly go easy on them, they may head down two destructive and costly paths: misdiagnosis and overtesting. Failing to properly diagnose hypochondria for what it is can perpetuate a vicious cycle of fear and anxiety, increasing the likelihood of further doctor visits and tests.
Changing approaches to identifying and treating hypochondria requires medical professionals to strike a difficult but necessary balance: thoroughly scrutinizing patients' claims, while being wary of overselling or recommending a series of tests.
Fostering an environment of empathy and training health care providers, especially emergency physicians, to recognize and document hypochondriacs can help close the care gap between perceived and actual health problems. Referrals to mental health professionals who treat hypochondria with cognitive behavioral therapy and medications approved by the Food and Drug Administration to treat hypochondria create a realistic approach to addressing and validating hypochondriacs.
Implementing a medical billing code for hypochondriasis would also be helpful, as without it it would be impossible to track diagnoses and outcomes for patients who frequently visit emergency departments and primary care offices seeking reassurance and relief from anxiety.
At the same time, the healthcare industry needs to increase access to cutting-edge healthcare technology, such as full-body CT scans that can detect everything from fractures to blood clots, infections, inflammation and tumors in one fell swoop. Such tools, along with personalized health monitoring devices, can provide individuals with the reassurance and clarity they need to proactively manage their health concerns.
Full disclosure: I paid for a full body CT scan out of my own pocket. The results gave me great peace of mind. I am fully aware that the cost of full body scans needs to come down to be truly accessible (and I believe it will, given the competitive history). I also understand that not everyone will get the peace of mind that this procedure gave me. The clear results felt like a weight was lifted off my chest.
Providing people with the tools to understand and track their health indicators will reduce the psychological burden of anxiety for many hypochondriac individuals, who will also benefit from an enhanced preventive care environment just like their non-hypochondrial counterparts, ultimately leading to a more efficient and cost-effective healthcare system.
The U.S. health care system in general, and health care workers such as emergency medical personnel and primary care providers in particular, must work together to counter the myths about hypochondria and illness anxiety that have created a culture of misunderstanding and stigma, and to initiate appropriate treatment. The question is, will they do so?
Hal Rosenbluth is CEO of digital healthcare company New Ocean Health Solutions and co-author, with Marnie Hall, of Hypochondria: What's Behind the Hidden Costs of Healthcare in America (Rodin Books, June 18, 2024).
