Health: Health Check: Stoicism might save the NHS

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The Independent Culture
ONE OF the puzzles of medicine is why some patients feel ill while others, with the same symptoms, do not. Perhaps you think this is not a puzzle at all, but simply a matter of tolerance. Tolerance and stoicism are, indeed, qualities whose supply has diminished as pressures on the NHS have risen.

A newspaper I once worked for - the late lamented Sunday Correspondent - used to run a regular feature in which celebrities were asked to name which, in their opinion, was the most overrated virtue. Julie Burchill, I remember, chose tolerance, in keeping with the Thatcherite tenor of the times (this was 1990).

I thought of this last week after talking to a couple of GPs who were bemoaning the increasing demands on them from the worried well - people who fear that they may be ill, who are often unhappy and have myriad social problems, but for whom medicine has little to offer.

Doctors are paid to be tolerant, but these GPs felt they had reached their limit. They maintained that their capacity to help those who could benefit from treatment was being jeopardised by overwhelming demands from those who could not. Most doctors, if asked today which is the most overrated virtue, would, I suspect, agree with Ms Burchill.

One of those I talked to suggested that charging a fee for each consultation was the only way to sort the truly needy from the merely noisy. But charging, as he readily acknowledged, would be an exceedingly blunt instrument for the task. What is needed is some internalised restraint, a revived fashion for stiff upper lips, a campaign to make coping cool and stoicism sexy. Stoicism, not monetarism, is the way to save the NHS.

An editorial in the current issue of The Lancet throws some interesting light on the mechanisms that cause some people to feel ill while others, with the same set of symptoms, do not. Researchers have established that people who suffer dizziness are also more likely to experience anxiety and depression. However, efforts to establish the nature of the link, in terms of either a psychological or a biological mechanism, have failed because no explanation can account for the fact that there are some people who do not report symptoms, but have similar clinical signs to those who do.

The authors suggest that what we have here is an example of "self-focusing" - something that is also seen in chronic fatigue syndrome, irritable bowel syndrome, and patients who complain of chronic pain. Self-focusing is seen in individuals with a slightly gloomy or nervous aspect, who are inclined to look out for new sensations and to interpret them more negatively than those with a more positive outlook. "If a sensation such as dizziness is thought to be a sign of illness, it is more likely to be reported than if it were thought to be a normal response to a stressful situation," they write.

The importance of this is that the treatment of patients with chronic complaints needs to focus on both the physical and the psychological aspects. The standard GP rebuff when confronted by a patient with a new ailment - "What do you expect at your age?" - needs to be resisted, but encouragement to see symptoms as normal rather than abnormal can transform a person's outlook and hence their health.

Stoics are made, not born. The capacity to tolerate discomfort and suffering is heavily dependent on parental attitudes. Parents who are supportive rather than dismissive of a child who injures itself help to develop coping mechanisms. A parent who takes time off work and complains constantly sets a different example from one who rarely complains.

Stoicism can help you to keep a job and get through life. But it needs to be tempered by medical reality. Arthritis is an area in which the traditional stoic patient is treated later than he or she should have been. So is cancer. Complaining can be good for you.

Most minor ailments, however, will get better of their own accord, or if they don't get better they will diminish in importance. All treatments carry side-effects that may be worse than the disease itself. Doctors should be avoided wherever possible, and regarded as a court of last resort where not. It is always worth considering whether the best option, for patient and NHS, may be to let nature take its course.

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