Copperfield on the over-medicalisation of life and the rebranding of diseases
Oncologists in the US have hit upon an inspired way of cutting prostate cancer rates. And that’s simply by not calling it cancer any more. They point out that prostate ‘cancer’ is virtually universal in older men, and that the lowest grades rarely cause trouble. So prevalence and anxiety levels would be slashed by a rebrand to a less emotive term. Like ‘normal’.
After all, it worked really well for Covid, didn’t it? When coronavirus was rebranded as The Virus Formally Known as Covid, rates, and fear, plummeted. Now, what you think is a variant-induced fever is just the cosy glow of nostalgia.
Perhaps this idea of diagnostic downgrading could be applied elsewhere. The medical lexicon is so terrifyingly written that, even if the disease doesn’t get you, you’ll be frightened to death. Take heart failure. I realise it’s not great prognostically. But, as you’re reaching for a U&E form, the patient is expecting you to whip out a body-bag.
Similarly, anything involving the word ‘chronic’ is inevitably perceived as terrible verging on terminal. Chronic obstructive pulmonary disease, chronic fatigue syndrome and chronic pain syndrome are all chronically misinterpreted. But the priority for a radical rethink is chronic kidney disease, if only to stop those consultations with patients who’ve accessed their records one moment and found themselves Googling ‘dialysis’ the next.
Even minor childhood ailments need rebadging. On day duty we carelessly bandy about diagnoses like hand, foot and mouth, and slapped cheek. But to parents, they suggest something bovine junior’s picked up from the petting farm, and a visit from social services, respectively.
Worst of all, though, is the branding of variations of normality as pathology. Come on down, pre-diabetes. Literally. OK, those with an HbA1c 42-48 might need a kick up the lifestyle arse. But to the general public, pre-diabetes incorrectly suggests an inevitable march towards actual diabetes. And this might just tip their emotional baggage over the allowed limit, although that’s irrelevant as their travel insurance premium would now be prohibitive anyway.
Besides, it’s inconsistent. We don’t call mild cognitive impairment pre-dementia, do we? We don’t, do we? Actually, do we? I can’t remember, which is a worry.
Anyway, the growing movement against over-diagnosis has missed a trick. Maybe we can’t stop the medical profession planting pathological flags in seemingly healthy land. But we can stop it by giving that new territory a terrifying name, and that would be an easy win in the fight against over-medicalising life. I say life, but obviously I mean pre-death.
Dr Tony Copperfield is a GP in Essex.
Overmedicalisation? You mean hypermedicalosis major. I’d go the other way TC and actually bring more customers under our medical influence. We’re supposed to be esoteric! So that 18 year old with a tiny rash – “ah, now that’s minima temere”. And the recurrent worrier – “omnes in capita disease”. And those patients who have “oh, and another thing” – clearly Jimmy Cricket syndrome. This strategy is better than when the AI machines turn all diseases into number codes – ” ah Mr Proctalgia k59.4, please come in. ”
And I’d certainly rebrand PAs as “God’s gift to some blokes”…
The amount of over diagnosed ADHDs, autism, personality disorders, fibromyalgia. All to gain some benefits abusing the free system.
I’d like to volunteer another 2 names that need changing:
Heart failure – a confusing, vague and depressing name. I suggest: “heart muscle weakness”
“Psychotic” – confused by almost everyone with “psychopathic” as in “a psychotic killer stalks our heroine through the mean streets of Harrogate…” (I made that example up)
[OK just realised heart failure isn’t always due to muscle weakness. Still there must be a better name than heart failure]