The reverse placebo effect - Is going to the doctor making you sick?

We've all heard about the placebo effect – a patient starting to feel better after being given pills with no therapeutic effect, while being told they're real drugs. It's all in the mind. What I've been wondering for some time is the exact opposite – can a visit to the doctor actually make you sick?
There are several studies documenting this reverse psychological process and the more you interact with the medical system the more health issues appear.

I'm sure you must know of a person who seems to be plagued by medical problems, always going to the doctors, repeated stays in the hospital and they never seem to get better. At some point you start suspecting they're faking it and that the only thing they're suffering from is the Munchausen syndrome – pretending to be ill just to get attention and compassion. Truth is they're not faking it and there are psychological as well as physiological reasons for their deteriorating health.

The dangers of the annual check-up

The annual check-up many people have come to consider a must is one of the first steps on this dangerous path. In many cases people have to take time off to visit the doctor and since their taking the trouble they feel they should make the most of it. This goes especially for generally healthy people. Since you pay for insurance and taxes you feel like you're owed some attention. Have the doctors work a bit for the money they're getting.
In this frame of mind, people tend to amplify minor problems, they might have ignored otherwise. Since you're there, why not ask the doctor about it? Unfortunately, most doctors have no qualms ordering unnecessary tests so you end up investigating health issues that would have gone away on their own. (I have a friend who spent one year investigating a mild discomfort in the right side, that no doctor was able to figure out. They just kept sending her from one specialist to another and doing all sorts of tests until the pain disappeared on its own.)

Another danger of the annual check-up, which by the way does little as far as prevention is concerned, is that the doctor might prescribe some medicine for whatever minor issue shows up. It is a well-known fact that doctors are financially motivated to prescribe all sorts of (expensive) drugs. Something for hypertension, gastric reflux, arthritis, there's a pill for anything. According to one study, 25% of the drugs currently in use are unnecessary and many cause side-effects that damage your otherwise healthy organs.

Becoming a hypochondriac

In my opinion, worse than that is the psychological effect. Once they're prescribed pills for something like hypertension, people no longer see themselves as healthy, they now have a life-long condition, they become patients who worry about taking their meds every day and scheduling the next appointment. Being told that something is even slightly wrong, your state of mind changes and you become more aware of any other issues, after all you're sick and you're probably going to have other ailments in the future. You become more aware of your own mortality and feel the natural urge to fight it, so you end up going to the doctor for every other minor problem that might appear. Another major problem is that people have been conditioned to rely exclusively on doctors and pills and rarely make any effort to improve their life-styles. Why search for a diet that might reverse diabetes and keep blood-pressure down, when the doctor has already prescribed all the pills you need?

The Post Hospital Syndrome

The worst case, however, is being admitted to hospital, for whatever reason. You will, presumably, be cured of that original problem, but chances are you'll be going back to the hospital pretty soon. The figures are staggering – in the US one fifth of the patients are re-admitted in a month, generally for a different problem. It has been dubbed the Post Hospital Syndrome (PHS) and it is both physiological and psychological.

There's a simple explanation to it. Spending a few days in hospital is very stressful. There's a complete change of routine, you have to sleep when you're told or be awaken at night for a quick check-up or a shot. The food is usually unpalatable and the patient is often told to fast in preparation for a test that ends up postponed. Skipping one meal or two might seem a trivial concern but it adds to the stress and most people are malnourished while in hospital.
A major psychological issue is the patronizing way patients are treated. You're no longer a person but a case. A Romanian doctor started an awareness campaign about this problem after becoming a patient herself, which allowed her to experience the hospital routine from a patient's perspective. From having to wait in bed for the mighty, busy doctor to make the rounds to the indignity of being referred to not by name, but as 'the girl with the rare cancer'.
Such an experience takes its toll on a person's body and mind and the first few weeks after being discharged, they're left with a weakened immune system, which explained the high rate of re-admissions.

Although the re-admissions rate is lower in the UK, doctors there have started a program to improve the way patients are treated. The first change made – have the doctors show some respect by introducing themselves to the patient, hence the campaign hashtag #hellomynameis. Some hospitals have also provided foldable chairs on the wards, so the doctor can sit down even for a few minutes to talk to the patient, acknowledging the fact that they're persons, not just cases.

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