Be Your Own Doctor
People go to great lengths to avoid doctors, but it takes more than an apple a day. Now you need acupuncturists, activity trackers and online symptom databases, not to mention positive vibes. And as patients increasingly try to be their own doctor, doctors are trying to restyle themselves as storytellers.
For many Americans, the word qi doesn’t exist outside of Scrabble. A mysterious energy force that can be tapped with sharp needles? Pass the aspirin. But acupuncture is older and more time-tested than a lot of conventional medical practices. In the 29th century B.C., Chinese folk hero Fu Xi is said to have fashioned nine needles for medical purposes, long before Hippocrates, the ancient Greek father of Western medicine, discovered the precursor of aspirin by chewing on willow leaves. And Hua Tuo, who revolutionized surgery in China in the second century A.D., eased the warlord Cao Cao’s agony by pricking his pressure points—at least until Cao had him executed in a fit of rage.
Although qi may seem far-fetched to some, acupuncture does work. According to a 2012 study published in the Archives of Internal Medicine, the precision needling effectively treats chronic pain. Yet in the U.S., acupuncture is still classified as alternative medicine, its practitioners lumped together with the garlic munchers and miracle healers, excluded from government health care systems such as Medicaid and Medicare. Conventional medicine is set in its ways, and physicians swear their professional oaths to Hippocrates rather than Fu Xi or Hua Tuo.
Conventional medicine finds its roots in ancient Egypt with Imhotep, the brilliant Third Dynasty polymath who identified more than 200 diseases. The ancients certainly needed Imhotep’s help: Archaeologists have discovered mummies ravaged by ulcers, bone tumors and clogged arteries. There was such a deluge of sickly Egyptians that doctors of the age codified hypochondria itself as a condition.
Today’s prospective patients can type their symptoms into the free medical database Isabel. The website lists 6,000 diseases, quite a leap from ancient times. But this internet Imhotep has upgraded hypochondriacs’ weapon of choice: self-diagnosis. According to Isabel, a young woman in North America with a headache may be suffering from any of 32 maladies, including acute mountain sickness, even if she lives at sea level. Looking up a simple stomach pang or muscle cramp on Isabel can be a harrowing experience, as the list of degenerative, nerve-killing and mind-eating diseases sprawls across the screen with links to images of gangrenous limbs. It’s enough to make anyone turn to Imhotep’s most famous prescription: “Eat, drink and be merry, for tomorrow we shall die.”
The overlap between doctors and authors has a long history. In antiquity, Apollo was the god of poetry and medicine. Nineteenth-century Russian physician and writer Anton Chekhov claimed, “Medicine is my lawful wedded wife, and literature is my mistress.” Other writer-medics include Sir Arthur Conan Doyle, John Keats and Khaled Hosseini. It’s understandable that doctors would turn to literature to explore their experiences. Like writers, they apprehend the full spectrum of life, the births and deaths, the triumphs over disease and the diseases that remain unvanquished.
Storytelling itself is now a classroom subject for med students. In 2000, at Columbia University’s medical school, Dr. Rita Charon founded the first narrative medicine program. Her students read the fiction of Henry James, among others, and learn how to write a patient’s story instead of just prescriptions. By acquiring patient histories as narratives, doctors become more thoughtful in diagnosis and treatment. They look beyond their pulse oximeters and blood pressure gauges to cure the whole patient. In his poem “The Chart,” contemporary poet-physician Rafael Campo, a professor at Harvard Medical School, reflects on a grandmother, “who died too young from a condition that / some doctor, nose in her chart, overlooked.”
In 1999 Jason Maude’s three-year-old daughter, Isabel, was diagnosed with chicken pox. But her doctors missed the near-fatal complications of necrotizing fasciitis and toxic shock syndrome. Isabel’s heart stopped twice during her stay in intensive care, and skin from her thigh had to be grafted to her stomach to replace dead tissue. The experience spurred Maude to cofound an online medical tool that people could use to research and better understand their illnesses. He named it Isabel.
But don’t think you can cancel your checkups and just go online instead. Maude says the goal is “not to replace the doctor but to be an adjunct.” His hope is that doctors too will use Isabel (isabelhealthcare.com) to avoid the misdiagnoses that threatened his daughter’s life. And many physicians have embraced it: The American Medical Association and The British Medical Journal both refer to the symptom checker. Isabel’s detractors, however, claim a computer doesn’t have the deductive skills required to prioritize which symptoms are important. Then again, the argument was made that computers couldn’t fathom the intricacies of chess, right up until 1997, when IBM’s Deep Blue defeated chess grandmaster Garry Kasparov.
The wealthy British narrator of Jerome K. Jerome’s biting 1889 satire Three Men in a Boat thinks he suffers from every disease in the book, with the sole exception of “housemaid’s knee.” “I was a hospital in myself,” he concludes, rather upset that he doesn’t have this particular form of bursitis. This classic hypochondriac demonstrates how tempting it is to overdiagnose oneself. And now it’s easier than ever! The Isabel website and its related app allow such “walking hospitals” to draw their own conclusions about their diagnoses without having to peruse a more in-depth, authoritative medical tome.
On the other hand, so to speak, the sleek wristbands known as activity trackers provide concrete, authenticated data about an individual’s health. They count every step you take and every second you sleep. They provide constant updates about blood pressure and heart rate. An activity tracker could have done wonders for Three Men’s doddering narrator. “I tried to feel my heart,” he says. “I could not feel my heart. It had stopped beating.” When he finally goes to the doctor, he is given a prescription for exercise, sleep and to ignore “things you don’t understand.” Sound advice.
Depression leads to a higher risk of heart disease. Worriers are more susceptible to the flu. Anxiety worsens irritable bowel syndrome and produces peptic ulcers. The list goes on and on. If a negative state of mind can so dramatically damage one’s health, then perhaps positive thinking can help. Evidence supports this argument. Listening to music, for instance, aids in stroke recovery. And the most powerful pill in the world is the placebo: Completely inert drugs have been shown to relieve pain, eradicate angina and even sprout hair from bald heads. If people simply believe they’re getting better, they often actually do.
Most health-conscious people instead attempt to avoid medical catastrophes through positive living. The data collected by activity trackers prod the trackees to get enough exercise and control their caloric intake. The consumer potential of these devices is so great that even Apple has gotten in on the action. When announcing the company’s slick new activity tracker, the Apple Watch, CEO Tim Cook said it “gives us the ability to motivate people to be more active and healthy.”
How can we maintain a positive attitude in the face of goiters, mumps and measles, or when every day brings forth a new crick or a symptom of some surely fatal disease? We could laugh away the worry. Patch Adams—clown, doctor and subject of a biopic starring Robin Williams—has dedicated his life to helping sick children by distracting them with a red false nose and a joke. Or we could give daydreaming a try. A 2008 study in Psychotherapy Research concluded that daydreaming produces positive emotions in cancer patients.
The BBC miniseries The Singing Detective explores this more literal take on narrative medicine. Protagonist Philip E. Marlow lies bedridden, maimed and hospitalized during an aggressive case of painful, crippling psoriatic arthritis. To escape the prison of his body, he drifts into an imaginary world of hard-boiled noir, spy intrigue, show tunes and beautiful women. He fashions a new narrative for himself, in which he’s a suave, able-bodied sleuth with perfect pitch. Screenwriter Dennis Potter, who created the show, suffered terribly from the same disease; he even had to lash his pen to his hand in order to write. Perhaps he also transcended his illness with a good story.