Health Care Junkies and GDD.

I would estimate that at least 10% and maybe more accurately 20% of GDD sufferers fit into the category of health care junkies. The most obvious ones are those who frequently see formal doctors, get more tests ordered, and go to the Emergency Room frequently, for all kinds of ailments. Perhaps most commonly, strange body pains and their feeling of some kind of bad heart beat. The majority of GDD sufferers have fallen into the frequent visit to the ER trap. In some ways this behavior reminds me of watching nature programs and occasionally see some kind of prey (like a mouse) teasing repeatedly a predator, like a cobra: cobra strikes, often misses because the mouse dodges the strike, then they go back and tease the cobra again... and eventually the cobra gets them. Now these animals, and maybe humans do this more often: seek thrill from the danger (thrill seekers) but this is a different impetus than health care junkies, it is not a sense of thrill that they seek medical help, it is a panic (hypochondria) that drives them to health care) but they don't seem to realize that eventually the cobra will strike them.

GDD is just such a cobra from getting MRIs. Those who get excess CTs have the prospect of radiation-induced cancer, and if they have poor kidney function, the iodine contrast may result in development of renal failure.

What I find remarkable, but maybe I shouldn't, because it is ingrained in them.. After the diagnosis of GDD, and knowing they have GDD, a sizable number still remain health care junkies.

Now alternative medicine junkies are of the same ilk, with the variation that they eschew modern western medicine, but still have that dangerous disposition. More often the risks, though very real, are less likely to be very damaging, that is kill you. But ofcourse bad supplements, especially from some foreign countries certainly can kill you. Nutty supplements also ill-advised. Never eat rhino horn, Pangolin scales, tiger bone or whatever. These supposed traditional ancient eastern alternative health practices must be banned everywhere with stiff penalties including prison.

I quite often ask: "why, why would you get that (eg_ a spinal tap, or some nuclear medicine study) when you have already learned that seeing too many doctors and getting too many tests has given you GDD. Why? Why?"

I tell people "stop it" but it often doesn't work, because this propensity is likely a genetic predisposition, like alcoholism or gambling..

In general men tend to avoid health care more often than women, and partly due to that genetic, I am resistant to seeking health care for anything in particular. In large measure this opinion is not as irrational as it may be for many, for two reasons. 1. I do not have a strong family history for genetic-type cancers or other serious diseases (eg: early cardiac death); diet reasonable; moderate physical activity; relatively good at compartmentalising stress. and 2. Being in medicine and a radiologist for many years, I have seen ample evidence of bad outcomes in medicine, especially from overtreatment or unnecessary advanced treatment, so I am well aware how things can go bad very easily with medical care. So relatively little of my resistance is the resistance of a small child or a pet from getting a large thorn taken out of them, or taking some kind of pill that actually has a high chance of helping them.. The risk I take in me of being a medical health care minimalist is 1 in 100,000 that something bad is actually there, like pancreatic cancer. This balances against the 1 in 1,000 or 1 in 10,000 risk that health care junkiness will result in a very bad outcome. I do also oppose the oposite tendency I have seen in colleagues, even those who are accomplished radiologists, who don't want to undergo (even MRI) because they don't want to know if they have whatever, cancer, etc.. What I think about them, and these include friends of mine, do you really not know anything about the overall approach of medicine (other than how to interpret the findings on imaging of studies on other people), the important concepts of early diagnosis and early treatment?

It is reasonable to inquire, if you are so adverse to seeking health care Dr Richard Semelka, why did you get 15 GBCA injections? The answer is: to test both GBCAs and MR imaging sequences before trying them on patients. My over-arching opinion, if I am not prepared to get something that is probably not dangerous, or that is likely to be helpful but requires tweaking (like an optimized MR sequence that actually shows disease well) why should I subject a patient to it? If it is unpleasant, when it doesn't need to be, or generally poor or worthless, I do not want a patient to be subjected to it... and ofcourse obviously if it is dangerous without sufficient benefit, I would never subject a patient to. So to test accuracy and minor safety issues for things I thought were essentially extremely safe: Generally Recognized as Safe (GRAS, an FDA term) for altruism, and secondarily for cancer screening purposes on myself.. As an aside, my secondary interest in self-screening also shows that in general I support the concept of whole body screening with MRI, because I did it on myself.... BUT... it is expensive and very low yield for all comers, and would need to be done at regular intervals (every 3-5 years) if you seriously intend it to be a life saving tool in you... but I digress.

Resist the urge to be a health care junkie, especially after you have been bitten by the cobra. For all comers there may be a 1 in 100,000 chance the health care junkyism strategy has been a good one, but a 1 in 1,000 to 1 in 10,000 that the strategy is bad; cobra has bitten.

There are no 100%'s, just better odds. This has been considered part of the art of Medicine, but I think better thought of as better understanding and more knowledge of the nuances of the science of Medicine and of probabilities (risk/benefit analysis). But as with sports betting (which I don't advocate) the odds change based on your condition.

And yes, this returns to applying the Goldilocks principle: everything in (thoughtful) moderation.

Richard Semelka, MD