Mental health articles

Medicalization

Medicalization is defined as physicians transforming the events of life (job dissatisfaction,workplace conflict, marital strife, parenting problems, etc.) into diseases. This occursfrequently with neck, back, and upper limb symptoms being considered as diseasesinthe absence of clear pathology. The physician thought process may be that if there aremusculoskeletal symptoms, there must be musculoskeletal pathology to explain thepresence of the symptoms. Yet, the English language containsthese idioms “Myneighbor is a pain in the neck” (meaning my neighbor’s obnoxious behavior makes myneck hurt) and “My boss is a pain in the butt” (meaning my boss’s behavior makes my lowback and buttocks hurt). Despite these idioms being universally used, many times physiciansmedicalize neck and back symptoms from such sources as “degenerative discdisease” or upper limb “tendinitis” with no objective findings on examination and only age appropriate degenerative findings on imaging studies. Linton’s review found thatpsychological factors are associated with the reported onset of back and neck pain, andthat psychosocial variables are clearly linked to the transition from acute to chronic paindisability (Linton, 2000). Hoogendoorn’s review identified multiple work and privatelife factors as risk factorsfor low back pain (Hoogendoorn, van Poppel, Bongers, Koes,& Bouter, 2000). These psychosocial factors probably do not change the spine, butrather, when normal human minor spinal pains occur, physicians transform these commoninnocent symptoms into diseases by medicalization.

The two keys to prevent medicalization are for physicians to diagnose, and codeoffice visits as symptoms until there is a clear objective pathologic basis for a diseaseor injury diagnosis, and for physicians to realize what normal aging looks like onimaging studies. The diagnoses “pain in the limb, ICD-9 729.5,” “low back pain ICD-9724.5,” and “neck pain ICD-9 723.1” are acceptable for charting and billing, and theseindicate that the source of the symptom is not yet scientifically established. This leavesthe physician room to explore psychosocial issues and leaves the patient open tosuggestionthat symptoms may not be due to serious disease. Conversely, if maritaldistress is labeled by a physician as “degenerative disc disease,” the patient becomesconvinced there is a medical disease present that needs medical treatment.

Tags: Medicalization, physicians