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9: How should people avoid being ‘labelled’ with an ‘illness’ and getting unnecessary treatments?

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Medicine has made amazing advances: vaccines and antibiotics for preventing and treating infections; joint replacements; cataract surgery; and treatment of childhood cancers, to name but a few. But that success encourages medicine to extend its reach to areas of less benefit.

To a person with a hammer, the whole world looks like a nail; and to a doctor (or a drug company!) with a new treatment everything looks like an illness. For example, as better treatments for diabetes and high blood pressure have become available, the temptation is for doctors to suggest their use to patients with only slightly abnormal results. This dramatically increases the number of people labelled as diabetic or hypertensive, ‘medicalizing’ many people who once would have been classed as normal.

In addition to any adverse effects of (sometimes unnecessary) treatment, this ‘labelling’ has both psychological and social consequences, which can affect a person’s sense of well being, as well as creating problems with employment or insurance.

So it is important for patients and the public to recognize this chain of events; to pause and consider the likely balance of harms and benefits before too hastily agreeing to a treatment. Screening commonly causes these problems of labelling through overdiagnosis, and potential overtreatment.

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The first defence is to be wary of labels and proposed further investigations. The seemingly flippant remark that a normal person is someone who has not been investigated enough has a very serious side to it. So it is always wise to ask whether the illness is considered high or low risk.

And, as we suggested earlier, also to ask what would happen if nothing immediate was done: how might the condition be monitored, and what would be the signal for action? Some doctors are relieved that patients don’t want immediate treatment or tests. But other doctors fall into the labelling trap – label = disease = mandatory treatment – not realizing that the patient may be quite happy to wait and see if the problem gets better or worse by itself.