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His last words? "But I feel fine!" - (6/22/2021)

By Dr. Ron Gasbarro

Why do some people avoid medical care? Is it due to an anxiety disorder? Or is it an actual phobia, an irrational fear that can undermine one's health and even shorten one's life? The pharmacist watched John, 55, scan the shelves of the vitamin aisle, frown, and then walk up to the pharmacist. "Do you have anything natural that can protect me from a heart attack?" John asked. "Is there something wrong with your heart? Do you feel OK? Maybe you should see your doctor," the pharmacist suggested. "Oh, I don't have a doctor," John replied. "I really don't need one."

When a patient who is well into middle age asks about alternative medicine – like an herb or a vitamin – for his heart, something is wrong. Is he having chest pains or palpitations? If so, why not see a doctor? While the pharmacist is not diagnosing John, he wonders if his reluctance to seek medical help is not a psychiatric problem. Indeed, there are pop psychology terms for reluctance or avoidance of medical care. For example, tomophobia is the intense fear of surgery or surgical procedures. Tomo- comes from the Greek tómos, meaning "cut or slice." Iatrophobia is the extreme fear of doctors, with the prefix iatro- meaning "healer or medicine."

According to a slew of surveys among American adults, people often avoid seeking medical care even when they suspect it may be necessary. One in 3 survey participants reported avoiding medical intervention. Even individuals with major health problems, such as breast cancer or having symptoms consistent with a malignancy, do not seek medical care. For example, one study revealed that 17% of patients with rectal tumors admitted that they waited a year or more to seek medical consultation after noticing symptoms, such as bleeding. Some patients even wasted up to 5 years before being diagnosed. Avoiding medical care may result in late disease diagnosis, complicated treatments, increased suffering, and reduced survival.
  
Tomophobia or iatrophobia - or whatever you want to call it - symptoms of medical care reluctance include: 1) Putting off getting routine care. "The doctor will tell me to lose weight, which I will when I have time." 2) Convenient forgetfulness. "I know I am out of refills. It's just for my potassium anyway. I don't think I need it. I feel fine!" 3) Fearing fear itself. "I don't like pain or needles. I don't have time for bad news. It will heal by itself." Some people are not phobic at all. They simply cannot afford medical care. In those cases, they may self-medicate and hope for the best. 

To treat medical anxiety successfully does not necessarily involve the use of medications. Instead, some therapists opt to use cognitive behavioral therapy (CBT). CBT is a type of psychotherapy whereby negative thought patterns are challenged to alter unwanted behavior patterns. With this type of treatment, the patient meets with the therapist and, in a systematic and gradual progression, confronts the source of fear while learning to control their physical and mental reactions to it. Such therapy could possibly save a person's life. 

What is it like to live with a medical phobic? Ask John. "Oh, the wife is into all that stuff. She is constantly after me. ‘Get a flu shot! Get a colonoscopy! Get your blood pressure checked!’" said John. "I told her that if she doesn't get sick, then I won't get sick. It's that simple." Evidently, John lives in a hermetically sealed bubble, thought the pharmacist as John cheerfully ambled out the pharmacy door. 

Ron Gasbarro, PharmD, is a recovering pharmacist and writer-in-residence at Rx-Press.

 


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