- If a doctor were to tell you that you had cancer, how would you feel in that moment?
- If you were later to understand that you had heard the word "cancer" but that the doctor really said "carcinoma in situ," which is not actually cancer but a precancerous condition, what would you feel then?
- If you did hear the doctor correctly saying "carcinoma in situ" the first time, would you have freaked out still? Would you have known "carcinoma" is not really cancer?
- Forget cancer or carcinoma, how does it feel to be told you have something wrong with you?
What's in a diagnosis?
A diagnosis is inherently a label that denotes that sickness or pathology is present, be it cancer or a cold. Invariably, a diagnosis is then associated with negative emotional responses and automatic negative assumptions, which stimulate your stress response to varying degrees, depending how "bad" you perceive your diagnosis to be.
For instance, if your mind labels spiders as "bad," your fight-or-flight response will automatically fire even at the thought of seeing a spider. The same thing happens with a diagnosis. You don't want to be reminded or told that you are not well, whole or intact. Just knowing there is something wrong with you can get you trapped in a loop of negative thoughts, emotions and beliefs, which could have negative physiological implications caused by a heightened fight-or-flight response, including increased blood pressure, muscle tension and inflammation. These physiological changes, in turn, can negatively effect your body's natural ability to heal, your own capability to cope and function and ultimately your belief that overcoming this diagnosis is possible.
In reality, a diagnosis reflects a pattern of discordance or imbalance in the body that is caused by a variety of factors -- genetics and lifestyle behaviors being just two of them. When my patients understand they are not their diagnosis, nor are they prisoners to it, they start the process of breaking free from limiting beliefs and labels, enabling them to open the door to the possibility that a positive outcome is possible. They begin to perceive that their illness or life problem is a challenge that CAN be reckoned with, that other options for an outcome are possible, and that they have a choice on how they are going to go about handling their situation. They have a choice to expect good. And science does show that positive expectation can confer better health.
The Power of Expecting Good
For instance, studies have shown that optimists are healthier. Research has also shown that there is a correlation with positive expectancy and positive health outcomes. In the medical world, we refer to this positive expectancy as the placebo response. Reports in the British medical journal, The Lancet, for example, have found that the placebo effect rivals the results of pharmaceutical drugs and sometimes exceeds them in effectiveness. This research alludes to the notion that optimistic belief, or positive expectancy, stimulates the body's biochemistry and physiology such that it has a beneficial effect on the healing process. It is hard to have positive expectancy when your mind automatically sees a label or diagnosis as bad.
Think about it yourself. If you were told you had diabetes, what would it make you think about and how would you feel about it, about your chances of getting better and the idea of now having to take medication? Conversely, what if you were told that your body was showing an imbalance in its ability to process sugar? Would you feel the same or think the same thoughts? I personally feel more in control when presented with the latter explanation, as if I just need to find a way to get my system more balanced.
I do believe diagnoses are necessary as they allow us health care professionals to be able to understand the likely underlying pathology and be able to follow the appropriate guidelines and procedures. The issue for me? How do we present the perceived diagnosis to patients so that they can maintain positive expectancy or the belief that they can get better or at least, be less fearful of what is to come next? Perhaps the next step is to conduct studies that look at the placebo response and other outcome measures in patients who are given a diagnosis versus a "big picture" description of the diagnosis.
Medicine and Language
To a certain extent, the medical world may be leaning in the same direction. Recently, a team of experts from the National Cancer Institute, recommended that the word "cancer" be redefined and not used in conjunction with some common diagnosis such as "ductal carcinoma in situ of the breast," which are premalignant conditions, not cancer. In their recommendations published in this week's issue of The Journal of the American Medical Association, they argued that the word "cancer" is not only extremely frightening to patients but it also triggers patients and health care workers alike to seek highly invasive and costly work-ups and procedures that can be unnecessary and harmful. "Changing the language we use to diagnose various lesions is essential to give patients confidence that they don't have to aggressively treat every finding in a scan," Dr. Norton, one of the team experts, told the New York Times. "The problem for the public is you hear the word cancer, and you think you will die unless you get treated. We should reserve this term, 'cancer,' for those things that are highly likely to cause a problem."
I tend to agree with this team of experts, though in my mind, it is also important to be very clear about how any particular condition is labeled. At least for now, it is good that medical experts are giving some thought to the words we use and their associated implications.
For more by Eva M. Selhub, M.D., click here.
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