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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Medical Myths Medical Myths
 

Are You Worried Well?


October 10, 2013

By Robert H. Shmerling M.D.

Beth Israel Deaconess Medical Center

 

Perhaps it does no good to worry, but that's exactly what many of us do when thinking about health and disease. If you have you ever tried to worry less about your health, you probably found that it wasn't easy: The entertainment industry, advertisements, news media and hearing about the health problems of friends and family do little to reassure.

Doctors often refer to people who are healthy but concerned about a particular health problem as "the worried well" and in many doctors' practices the worried well make up a large proportion — or even a majority — of office visits. If we are worrying about the right things and taking the appropriate steps to reduce risk, all that worry may be a good thing. After all, preventive measures are considered among the most effective ways to maintain health. But are we worrying about the "right" things? If you listen to the nightly news, you may find yourself worrying about a health risk that is minute or simply does not apply to you. For example, Lyme disease gets a great deal of media attention but is nearly unheard of in certain parts of the country. Is Lyme disease a real threat or merely myth in your neck of the woods?

Perception Versus Reality

While research shows that people are rightly worried about heart disease, for which many people are at risk, there otherwise would appear to be little overlap between our fears and concerns and which conditions have the biggest effect on longevity.

What Most People Worry About

A 2006 Gallop poll survey asked respondents in the United States, "What would you say is the most urgent health problem facing this country at the present time?" Besides access to health care (30%) and its cost (26%), here's how people answered:

    1. Cancer (14%)
    2. Obesity (10%)
    3. AIDS (2%)
    4. Diabetes (2%)
    5. Heart disease (1%)
    6. Flu (1%)
    7. Drug and alcohol abuse (1%)
    8. Smoking (<0.5%)

    A more recent survey, from November 2012 found that obesity was the condition at the top of the list. Cancer, heart disease, diabetes, AIDS and flu followed far behind. (Other top “health problems” reported were poor access to care and cost of care).

    What Most People Should Worry About

    When analyzed by the number of deaths in the United States, these are the most important diseases:

    1. Heart disease
    2. Cancer
    3. Stroke
    4. Chronic obstructive pulmonary disease
    5. Accidents (including motor vehicle accidents)
    6. Pneumonia and influenza
    7. Diabetes
    8. Suicide
    9. Kidney disease
    10. Chronic liver disease and cirrhosis

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    Worrying Well?

    The differences between these two lists might indicate that many of us are worrying about the wrong things. On the other hand, context matters:  the most important health concern for an unmarried, sexually active and otherwise healthy young adult may be sexually transmitted diseases while an older person might worry more about cancer or stroke. In addition, differences in these lists could be related to how they were compiled. For example, in the survey, people may have considered nutrition an issue that included obesity, heart disease and cancer.

    In addition, the numbers of deaths each year may not be the only way most people think about what concerns them the most — death from a stroke at age 90 may not be viewed as more important than drug abuse or alcohol abuse among teenagers or young adults. Even so, surveys have repeatedly found that the relative importance of heart and chronic lung disease tend to be underestimated.

    Considering the effects of cigarette smoking and other lifestyle factors on the development of many of the top killers, try to focus on smoking cessation, exercising regularly, maintaining optimal body weight and improving your diet. Assuming that many or most accidents, including those in automobiles, are preventable, take steps to reduce their likelihood or reduce their impact (by driving more slowly and wearing a seatbelt, as examples).

    Talk with your health care professional about how often to have cholesterol, blood sugar and blood pressure measurements, and whether you should get pneumonia and flu vaccinations. All of these actions are better ways to channel your health concerns than worrying about a type of cancer not known to be preventable.

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    The Bottom Line

    For many, worrying is not something one chooses to do — it just comes naturally. But worrying can be a positive thing if it gets us to change our behavior or in some other way helps us to reduce the risk of illness, injury or premature death.

    With so many options, we might as well focus on the most important health risks we face, especially those we can change. All that other worry about exceedingly rare diseases or events (especially those we cannot change) can make life less pleasant or even cause crippling anxiety. If you can channel that worry into constructive action, it may be much easier to accept the risks you face, and it may even lead to an improvement in your health.

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    Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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