published in Khaleej Times on Nov 11, 2009
I know a man who has seen a thousand doctors. Let us call him Thomas. He is 80 years old but even so, a thousand is a huge number. In a year, he would have seen 12 new doctors on the average. A thousand different doctors means perhaps 20,000 consultations. Sometimes Thomas sees three different doctors in one afternoon.
Some of Thomas’s friends are doctors. Some of his doctors become his friends. His doctors range from the junior to the senior, from those in government hospitals to those in private practice, from generalists to specialists. Men, women, foreigners, graduates from local universities; he has seen them all. Sometimes he sees them just to measure his blood pressure.
Sometimes it is for a more serious matter like an unexplained chest pain. He has spent about $230,000 in his lifetime on doctor visits, blood tests, medications, X-rays, scans and minor surgeries.
He has no regrets. Others may splurge on flashy cars or the services of a sommelier, but for Thomas it is doctors, doctors and more doctors. Sadly, Thomas was diagnosed with lung cancer recently and was referred to me. I wonder how many more oncologists he has seen or will be seeing.
Thomas came across as a well adjusted gentleman. He did not exhibit any verbal or physical tic. He spoke well. He gave his medical history clearly and answered most of my questions willingly and appropriately. Having gained his trust, I decided to explore his need to see so many doctors. He was forthright about it. He is afraid to die.
So many of us, with or without cancer, are not willing to admit to our fear of death. We couch our fear like this: “Doctor, I am not afraid to die but I fear the process of dying.” Others of a more poetic bent will say, “Oh, death, where is thy sting?” It is a badge of honor we proudly wear on our sleeves.
Thomas was afraid of death, and he was not afraid to admit it. That’s courage. He was going to do his best to postpone it. Of course, seeing a thousand doctors does not help. It may even be harmful. Conflicting opinions lead to confusion and anxiety. Excessive and unnecessary X-rays and CT scans increase the chance of radiation- induced cancer.
Apart from his fear of death, Thomas also disclosed a distrust of doctors. He was seeking as many opinions as possible before deciding on treatment. He had his doubts. Now you know why I gave Thomas his moniker.
Is Thomas suffering from hypochondriasis? The condition is characterised by fears that minor bodily symptoms may indicate a serious illness. The hypochondriac constantly examines himself; self-diagnosis becomes a preoccupation. He expresses doubt and disbelief in the doctor’s diagnosis. Thomas has some traits of a hypochondriac but that is too easy a label to stick on him. Thomas had a CT scan of his chest two years ago that disclosed a shadow in his lung. He was treated for pneumonia. The possibility of cancer was excluded when most of the shadow disappeared with a course of antibiotics. The doctors should have gone the extra mile to exclude cancer with a PET/CT scan and a biopsy.
Some may diagnose Thomas with thanatophobia — an undue obsession with death (especially one’s own) to the extent that it becomes psychologically crippling. Again, this would be too convenient a label. Thomas is a successful entrepreneur and is socially adept.
I really don’t know. We tend to medicalise every little symptom and discomfort. From an infant’s excessive crying to teenage angst to a wage earner’s blues. There is a pill for everything: insomnia, erectile dysfunction and the sadness of bereavement. Perhaps Thomas has the time and money to see many doctors and he feels good doing this. It is therapeutic for him, if you can forgive my use of the word. It may be no different from some others I know who spend as much as Thomas does on audiovisual systems or eating unmentionable parts of endangered animals.
I shall help Thomas fight his cancer. I will dissuade him from unnecessary blood tests and scans. I will not judge him. Most of all, I will not medicalize his fear of death. It is about being human. There is no pill for it.
Albert Lim Kok Hooi is an oncologist based in Kuala Lumpur