" The harm doctors do when patients are labelled 'anxious' "

[Kyla]

http://www.theguardian.com/commenti...to-our-patients-when-we-label-them-as-anxious

Excerpt:

...The insidious way in which being labelled anxious can harm patients was recently brought home to me by a former cancer patient who has spent years trying to disprove a diagnosis of anxiety in order to obtain income protection. His hospital discharge summary had carelessly listed anxiety as a diagnosis after he had sobbed one night at the uncertainty of his situation.

“Try insisting you’re not anxious – it’s an invitation to be labelled anxious,” he said wryly.
On the rounds I am about to begin, our patients will be mostly very ill. I will teach my residents that as benign as we might seem to each other, everything about us, and the hospital environment, creates anxiety. This anxiety isn’t pathological but normal. What’s more, it’s usually eased with better communication, empathy and acknowledgement that if we were in the patient’s shoes, we too would feel the same way...

 

[Hip]

The newspaper article gives no indication about what disease the former cancer patient has spent years trying to obtain income protection for, and no explanation as to why having a diagnosis of anxiety prevents claiming income protection.

 

[Woolie]

Also from the article:

...in the hospital, anxious takes on an entirely new meaning. Rather than a mere descriptor of a patient’s affect it fast becomes the prism through which the whole patient is viewed, and alas, often dismissed. An anxious patient can have a host of visible problems but the term anxious overshadows them all, detracting from better care of the ailments that may well have created the invisible anguish.
...
I am speaking about the average patient in hospital who is vulnerable, usually ill-informed, steeped in well-intentioned but fragmented medical care, who sheds a disconsolate tear or looks upset and is quick to be labelled anxious. And before you know it, the label is tossed from doctor to nurse (or the other way around), from one handover to the next, until the occupant of Bed 17 becomes “that anxious man” instead of the human being whose hip is broken, whose pain is mounting, who doesn’t speak English and whose family is out of sight.

Every seasoned doctor can recall a time when an anxious patient had an excellent reason to be anxious – an evolving infarct, unsuspected internal bleeding, a pulmonary embolus or more commonly, doctor-patient communication gone awry, so that the space which reason and understanding should have filled is instead taken up by dread.

 

[Woolie]

This is a good time to mention some other data hinting at the dangers of being classed as anxious - especially for women (click on the author names for links to the articles if interested):

One comes from the study of patients with acute coronary syndrome, where a delay in diagnosis can have potentially serious consequences. A recent international cohort study of over 1000 such patients found that the presence of anxiety was associated longer diagnostic delays, particularly when the patient was female (Pelletier, Humphries, Shimony et al., 2014). An anxious presentation, especially when combined with female gender, may have led physicians to misattribute symptoms to psychogenic causes, thereby delaying correct diagnosis. Some further evidence to support this interpretation comes from Chiaramonte (2007), who presented a large group of family doctors and internists with vignettes describing male and females patients with identical risk factors and textbook symptoms of heart attack. The physicians were highly accurate in making the correct diagnosis in both cases. However, when key vignettes also mentioned that the patient had recently experienced a stressful life event and appeared anxious, only 15% correctly diagnosed the female cases, compared to 56% for the male cases. Again female gender, this time combined with reports of “stress”, may have contributed to a psychogenic misattribution.

 

[Snow Leopard]

This is a good time to mention some other data hinting at the dangers of being classed as anxious - especially for women (click on the author names for links to the articles if interested):

Where is this quote from?

 

[Woolie]

Where is this quote from?

Not from anywhere, I'm afraid, @Snow Leopard. Just my own notes.

 

[Hip]

You also have to recognize that anxious patients may vastly over-exaggerate the facts, and I imagine that is why doctors feel the need to label such patients as "anxious", in order to place the patient's statements into context.

I have experienced this over-exaggeration myself, when I have to deal with people on my website who have developed severe anxiety, triggered by a viral infection (my website is about a virus which seems to trigger anxiety disorder). Because of the high level of anxiety, these people cannot think clearly and rationally, and the anxiety magnifies all their problems, in their own minds, out of all proportion. I know, because I was once in this position of having severe anxiety myself.

It takes a lot of effort on my part to try to explain to them that their issues only seem so dire because they are viewing them through the lens of anxiety, which amplifies all worries and concerns.

I tell them that the first thing they should do is treat their anxiety, because once their anxiety disorder is brought under control, the problems that presently seem huge will become much less significant when viewed with a calm mind.

 

[Woolie]

@Hip, I think the problem, though, is when normal reactions to a stressful situation become pathologised. The people you're talking about might really suffer from clinical anxiety - at least at certain times.

But we are all capable of reacting to a stressful event anywhere from calm to frantic, and our response may depend upon a lot of factors that have nothing to do with clinical anxiety (other things going on in our lives, for example, an upcoming important event, etc). All these reactions are "normal", but when the label "anxious" is applied to these, a whole process of dismissal begins.

We need a different word for anxiety as a state - as opposed to a trait - but we don't have one, and that's where the confusion begins.

 

[Hip]

@Woolie
I would think that normal anxiety in healthy people is more of a transient affair. We can become anxious and worked up about something, but usually that passes after a while.

Whereas in a condition like generalized anxiety disorder (GAD), which is what I had, the anxiety is constant, and is not caused by events in your life, but is likely due to a biologically-caused disease state in the brain. The brain possesses anxiety circuits (in the amygdala and other places), which are designed to be switched on in dangerous or precarious circumstances, so that our senses and mental focus are sharpened, and we mount a proper response to those precarious circumstances. In this way, an anxiety response is part of out survival instincts.

However, it GAD it seems these anxiety circuits have erroneously been switched on permanently for no apparent external reason, due to a physical or biochemical fault in the circuit.


Although even with GAD, if external events in your life occur that would, even for normal people, cause stress and anxiety, then this will further compound the already high levels of anxiety you are experiencing from your GAD, and so the combined effect will send your anxiety levels through the roof.

I think when people have a nervous breakdown, this may be due to them first developing GAD as a biological disease, and then having to face some very anxiety-provoking life events, such as you might find in a stressful career.


Anyway, what I am trying say is that it can be hard to disentangle ordinary anxiety produced by life events, and anxiety due to GAD resulting from a physical or biochemical fault in your anxiety circuits.