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Medicalizing normal: why patients (and doctors) need to ask questions

Posted by Dr. Claire McCarthy  April 1, 2013 07:15 AM

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Let's say your kid is gassy. She seems okay, but you're not sure, so you decide to take her to the doctor--who, after listening to your story and doing an examination, says: "Your child is suffering from eructation and flatulence."

Well, shoot. And here you just thought she was gassy. Before the doctor said anything, your only plan was to keep the windows rolled down on the car ride home. But having heard this diagnosis, you are hoping that the doctor will do something--because some sort of test or treatment is necessary, right?

Nope. All the doctor said was that your kid is burping and farting--i.e. gassy.

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We doctors do this a lot, actually, this medicalizing of things that really aren't medical conditions. We're not so much doing it to sound smart or alarm people, it's just how we talk. And sometimes, making something a condition is easier for us because then we can offer tests and medical treatments, which is what we know how to do (seeing as how we went to medical school and all). The problem is, not all of those tests and treatments are necessary.

A less silly example: baby fussiness and spitting up. Lots and lots of babies have this. With rare exceptions, it's normal and goes away by itself; parental reassurance works as well as--actually, better than--any medications or other interventions. That doesn't stop us, though, from giving it a medical name--Gastroesophageal Reflux Disease, or GERD--and prescribing medications, which mostly do nothing.

In an interesting study just published in the journal Pediatrics, researchers from the University of Michigan had parents read a clinical scenario about a fussy, spitty baby and then answer some questions. What they found was that if the fussiness and spittiness were referred to as "GERD" rather than "a problem," parents were much more interested in medication--even when they were told that the medication likely wouldn't work. It wasn't that they thought that the term "GERD" meant that it was more serious, either. It truly seemed that for the parents, once there was a medical term involved, there should be a medical treatment involved.

In this case, medical treatment isn't a good idea. But in lots of other cases, treatment or tests might be a good idea. Without a medical degree, it's hard to know what to do. Even having a medical degree doesn't guarantee you'll know, because medicine is always changing as new studies teach us new things.

To help patients and families, and to help those well-meaning, busy doctors who may not have time to read all the latest studies, the ABIM foundation has started the Choosing Wisely Initiative. They have asked specialty societies to submit lists of 5 tests or treatments that doctors and patients should question, and to date more than 35 organizations (including the American Academy of Pediatrics) have done so. They also have patient-friendly resources from the specialty societies and Consumer Reports. Check it out, and spread the word.

It's all about asking questions, really. Which is what all of us should be doing--patients and doctors alike--if we want quality health care that everyone can afford. The science and technology of medicine is amazing these days--but sometimes less, and simpler, is better.

It's definitely better for eructation and flatulence, that's for sure. Hopefully your doctor won't pull out the prescription pad if ever your child is diagnosed with those--but if he does, start asking questions.

Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post.

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About MD Mama

Claire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »

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