We have all been through that phase at one point or the other when we wanted to fake or inflate an illness (this is not about the “Munchausen syndrome”, which is a serious disorder!). Faking illness is perfectly all right, as long as it is only to validate your application for leave of absence at your school or workplace. You may even want to place onions in your armpit to give your leave application a stronger standing, which is also totally fine.
But it is no longer okay when you want (or are made) to get this ‘invited’ fever treated, especially with sophisticated medical tests. Why? Because it is now a scenario of ‘medical overuse’ which is no longer your personal problem but a larger healthcare issue. The World Bank in 2014 warned of the excessive use of healthcare as a growing concern in India. Well, it’s been three years since, so it is fair to doubt if it still is a ‘growing’ concern.
The following could drive this scenario: the doctor you visit would get an incentive for treating you; he or she may not know the cause of your illness right away, and even if he smells a fake he may need a set of (and sometimes unnecessary) tests, unless you want to confess yourself; and you can afford this treatment, thanks to the numerous consumer-friendly insurance and government schemes to help you pay your bills; you don’t want to pay for it out of pocket and want to make the treatments insurance-claimable (because your reimbursement form demands more than a leave application), tempting you to go for unnecessary hospitalisation and tests, thereby transferring your burden on to the system you live in.
No, this is not always your fault. You may go to a doctor with a valid complaint of severe headache and be scared with the terms hypotension (nothing but low BP; complicated terms for minor illnesses is an interested topic by itself!) and anaemia. You may be made to undergo eye tests, asked a lot of questions on your work-related stress and made to wear spectacles for the minute power of 0.25 in your left eye, additionally recommended to go for anti-reflective coating on the glass that will help avoid stress to your eyes while on the laptop.
More visits
Your visits to the doctor don’t come to an end here. You are advised to visit an ENT specialist just to cross out sinus from the probable causes of your headache. And your headache? Its intensity hasn’t yet come down but your pocket is now much lighter (because the money has now been transformed into fancy spectacles that you wear at work).
Could you have survived without these additional anaemia tablets and spectacles? Absolutely yes. Because not all types of anaemia are fatal and a fatal case of anaemia would have many other symptoms, simple. This is a clear example of over-diagnosis and overtreatment, both of which are covered under the umbrella of ‘medical overuse’.
This brings to the forefront mediocre quality of healthcare and thrusts unnecessary high costs on you. Not a problem at all if you draw a taxable income, but what about, say, a daily-wage worker? (You’re probably thinking that a daily-wage worker wouldn’t even have approached doctors in the first place. Totally true.)
But does all this mean you should not have gone to a doctor at all for a headache, or waited until it became totally unbearable, or that you should have tried your own medication first? A big ‘No’! It only means you should be aware when the diagnosis becomes over-diagnosis. On the other hand, it is not always easy to identify medical overuse individually; defining and identifying overuse has been recognised as a complex process even by medical researchers.
But as with any other societal issue, you have a role as well in ensuring the “Prudent use of medicine for patient safety” ( The Hindu , October 29, 2017).
rsrikumar@povertyactionlab.org
