Is telemedicine attractive to hypochondriacs?

An article in MIT Technology Review takes a sideways look at telemedicine and asks if telemedicine is providing an easy route for people suffering from excessive anxiety about their health. The author, Christina Farr, suggests that the ease of contacting a doctor using telemedicine services in comparison to having to visit a doctor’s office and the ability use either insurance or direct payments makes these services more attractive to hypochondriacs (lately called those with somatic symptom disorder).
Views on the subject are quoted from the chief medical affairs officer at MDLive, Deborah Mulligan, and a board member of Doctor on Demand, Bob Kocher. While the first is able to relate an anecdote where a case of excessive anxiety disorder was identified and successfully referred to cognitive behavioral therapy, the latter says he isn’t aware of any patients with health anxiety regularly using the Doctor on Demand app.

Read the full article here.

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  1. I’m not a doctor, but even I can assure Doctor on Demand’s Bob Kocher that people with ‘somatic symptom disorders’ can and do take whatever steps they feel necessary to confirm/deny their symptoms. I’ve heard from literally hundreds of my Heart Sisters blog readers since 2009 (many repeatedly) who insist, despite no clinical evidence to support their fear, they are in imminent danger of a fatal heart attack. There’s a name for this known anxiety disorder: cardiophobia, or repeated complaints of chest pain, heart palpitations, and other sensations accompanied by intense fears of having a heart attack and of dying.

    My blog receives so many of these “It’s 2 a.m. and I think I’m having a heart attack” comments that I wrote a post about “catastrophizing” with that title. For example: “Going online to seek more information is a perfectly normal and predictable behaviour choice – whether we’re buying a new washing machine or wondering if those weird symptoms could mean a heart attack.”

    What each person is asking me for is reassurance. You’re fine. You’re not having a heart attack. Go back to sleep.

    If I am getting these predictable questions from readers around the world (and I’m not a physician!) it’s impossible to believe that sites like Doctor on Demand are somehow not.

    • Donna Cusano

      Carolyn–absolutely, if they are contacting you, it’s a wider problem. As you’ve pointed out, women’s heart attack symptoms don’t track like men’s and are harder to diagnose. A pulled chest muscle, spinal problems, a slightly bulging neck disc that radiates down the nerves of the arm can all give you pains that are hard to assess. (Speaking from personal experience)

      The relegation of health anxiety to ‘hypochondria’ is a bit of an overstatement in the article. In light of the RAND study (which is questionable in and of itself-TTA 8 Mar), another rationale for limiting patient-to-doctor telemedicine.

      • Your last paragraph is bang on, Donna. That word ‘hypochondria’ is so loaded (and let’s not forget, many women have had bona fide heart attacks dismissed as simply anxiety or stress – and that mistake can have deadly outcomes).

        PS A “bulging neck disc that radiates down the nerves of the arm” sounds awful!! :-(

        • Donna Cusano

          Spinal problems can manifest in nerve pathways in ways that are similar to the diffuse symptoms of heart attack. It can be confusing to those with histories….thus ruling out and ruling in is even more important. Agreed–dismissing real concern and wanting to clarify with lumping under ‘hypochondria’ is plain wrong.