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Article Title

“Who’s Worried?”

If we are in adolescence or younger, we worry about the far future. We worry about not having any control over our lives (i.e. the prearranged schedules and the regimented recreation), we worry about meeting someone else’s standards/goals, and we worry about safety.

If we are in young adulthood, we worry about finances and our economic status. We worry about defining and satisfying responsibilities including family, and we still worry about safety. And we also worry about relationships and our near future.

If we are in the “elderly” category, we worry about losing it all (materially/mentally). We worry about health and loneliness and being alone. We worry about catastrophic medical conditions including good and bad death.

In general, we worry about what’s going on thousands of miles away (the middle/far east) and we worry about a few feet away (i.e. in a shopping mall, gas station, movie, school, etc.). At any age, we worry about our privacy. Individually, the “worries” may not be overly dramatic, traumatic, or overtly consuming. But subtly and subconsciously, they may flood our life. Is it possible that “to worry” has taken on a new meaning; a new influence on behavior; a new threat to health?

When our parents or grandparents “worried” about something, the chances are they probably coped by feeling that 1) there was nothing they could do; 2) they’d try this or that; 3) this is just part of life – “life is a succession of worries.” Through the decades, there were monumental concerns that caused global worry, such as the great depression of the late 20s and early 30s, during which a way of life for anyone was threatened. But day to day, or sun-up to sun-set, there always have been routine concerns that somehow people coped with and were still able to sleep and function.

Today's worries, however, seem to turn into clinical stresses with more frequency and at greater volume. Increased stress in daily lives (not just monumental events) appears to correlate with the increases we see in depression and/or a variety of anxiety disorders.

As clinicians, should we be more alert to the day to day concerns (“What’s your day been like?”), no matter what the patient’s complaint is? Shouldn’t we be trying to see if our patient is so involved in “worrying” that the “stress” that could be consuming the patient is so distracting or so immune-compromising, that the patient is more vulnerable to physical ailments, causing more distractions and thus people are becoming more depressed or phobic or compulsive or sensitive to feeling the symptoms of panic attacks?

For example, look at students today. Look at any level of education – i.e. middle school through professional graduate school, and we see more test anxiety, more homework panic, less classroom comfort, and poorer time management. Look at the typical combination wage earner and parent of today. They have more concerns with “child attention/protection,” scheduling of activities, maintaining job responsibilities, and work place interpersonal interactions.

What usually happens when a patient comes into the office with pain in the shoulder, or a burning sensation when urinating, or a sinus headache, or a sudden onset of fatigue? We do our history and physical, but we do it with a focus on trying to see a tangible link to the shoulder or the headache or the fatigue. We eventually order an MRI or prescribe a medication, or conduct some other medical test. It is easy to say or to feel that our relationship should take on a different hue. Not just the robotics of diagnosis and prescribing. But that would probably require more time and energy per patient. What a cycle that would be. Imagine having more concern for the patient, which could mean more “worry/stress” for the clinician in terms of time management, reimbursement, etc.

With the direction medicine appears to be taking, while the clinician wants to be down to earth and think and behave true to the Hippocratic oath, he/she is becoming glued to the “bottom line.” In any endeavor (business or profession), “the bottom line” is “married” to “worry”! Perhaps that is why the clinician has to frequently ask him/herself, “Why did I choose this profession?” to begin with.

Perhaps the clinician has to ask not only the patient, but also him/herself, “Who’s Worried”?

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