Last year, the fifth edition of psychiatry’s
Diagnostic and Statistical Manual of Mental Disorders replaced the DSM-IV’s hypochondriac diagnosis with two new complaints: somatic symptom disorder and illness anxiety disorder. The first describes an excessive preoccupation with medical ailments that may or may not have physical origins (e.g. you have a slight gastrointestinal issue that you obsess over). The second, a subset of anxiety disorder, is an intense fear of health problems that persists in the face of professional reassurance. These diseases, which often unfurl in early adulthood, afflict men and women in equal measure. Their milder cousins are everywhere: at work, where your co-worker squirts Purell on his hands 20 times a day, and at home, where your spouse is Googling “stomach pain” and growing increasingly panicked.
The Web has inflamed all of our worst hypochondriac tendencies by making data on far-fetched syndromes readily available. But what about the people who already live and breathe that information? If my momentary Internet exposure to the science of my own metabolism was enough to make me sweat about horrible pathologies, then what is it like to be a doctor? Does every pang inspire dread? Do the seductions of self-diagnosis increase when you know whereof you speak?
They seem to for medical students. Medical student syndrome is a well-documented phenomenon, a one- to two-year phase during which aspiring physicians think they’ve contracted whatever disease it is they’re studying. A stomach gurgle becomes appendicitis. A mosquito bite heralds hemorrhagic fever. Everything is cancer. The research on medical student syndrome is less robust than the anecdata: Though one study from the 1960s found that more than 70 percent of medical students develop phantom illnesses, another study two decades later suggested that the effect was exaggerated—and that law students are just as neurotic about their health as their M.D.-seeking peers. (A third study revealed that psychology students grew more confident in their own mental health as training progressed, but were ever more likely to start diagnosing their family members with psychological disorders. Lovely.)
Doctors talk about medical student syndrome as a rite of passage. “I had the syndrome. We all did,” says
Leana Wen, an emergency care physician at the George Washington University hospital. Five other white coats I contacted for this article (some of them occasional contributors to
Slate) agreed. Matt Morrison, an emergency room doctor at St. Luke’s-Roosevelt Hospital in New York writes:
But something happens in your third year of medical school, when you begin your clinical rotations. Look more closely at the study that compared medical students with law students, and you’ll find that, while the average quantities of angst were similar, the med students fretted far
more than the law students during the first two years of their program and far
less during the last two years. As patients flow in and the dichotomy between
doctor and
doctored begins to solidify, a switch seems to flip. Beginning medical students think they’ve got every disease under the sun. Practicing physicians think they are indestructible.
Doctors make the worst patients, the adage goes. They seek medical treatment less and “tough it out” more. If you were to pick a population that was least likely to contain hypochondriacs, it might very well be physicians (though it is also true that, on average, physicians are
healthier than the typical person). “I think I minimize more now,” says
Jacob Sunshine, an anesthesiology resident at the University of Washington. “Once you have the expertise and the experience with people who are very sick, you can triage yourself and think things are probably OK.” And New York M.D.
Randi Epstein echoes: “I tend to be really optimistic when it comes to my health, as I thought most doctors were.”
Things only got more frank from there: “I know I’m fine,” Wen said on the phone. “My husband, too—he has to be dying to make me pay attention.”
Journalists read journalism. Soccer players watch soccer. Chefs patronize restaurants. Why are doctors so resolutely convinced they don’t need medical treatment?
Perhaps these anti-hypochondriac doctors are simply behaving rationally. As Sunshine notes, physicians are often qualified to diagnose themselves, and they realize that the most common afflictions are generally the least dangerous. Rather than endure the vagaries of the medical system (with which they can be all too familiar),
some opt to let conditions resolve on their own. Plus, “we’re really, really busy,” adds
Jordan Metzl, who specializes in sports medicine in New York. In the few hours that residents get away from the hospital or the clinic, they are unlikely to wish for further contact with the medical establishment. (When I asked Metzl about his doctor-going habits, he replied: “Hate it. Never go. Never.”) A
New York Times article from 2013 points to another factor: The piece, which reported on the less aggressive routes that doctors tend to take with end-of-life care, implied that working in medicine may give you a more realistic sense of the field’s limits.
In addition, doctors are … different. “Most of us have a reasonably high threshold for unpleasant things,” says Sunshine. I heard from several physicians who believed their white-coated fellow travelers were “tougher” than the typical patient. Again, these psychic calluses seem to develop in the third year of medical school: As Danielle Ofri
observes, that is the time that “figures prominently in studies that document the decline of empathy and moral reasoning in medical trainees.” Spending your day among the truly sick and suffering hardens you. Not only is there a self-protective impulse to shut out the pain of others, but you have less emotional bandwidth for minor complaints, particularly your own.
Hypochondria also represents a challenge to medical authority. “I’m not surprised you’re not finding many” doctors with the condition, Belling told me. “The main question of hypochondria is, ‘How can you know for sure?’ ” Often, it is a doctor’s job to be certain, to assure a patient that a negative test signifies a clean bill of health. But hypochondria arises from uncertainty, and “uncertainty exposes the difficult truth about medicine: There’s always room for doubt.” No wonder physicians resist such a subversive mindset. Hypochondriacs, Belling points out, are right about one more thing: Disease and degeneration never fail to win in the end.