The Obsession with Diagnosis: An Obstacle to True Health?
Reading the latest book by Irish neurologist Suzanne O’Sullivan pushed me to reflect on the obsession that often follows us when it comes to medical diagnoses. Even more so as, with age, aches and discomforts start to pile up. Perhaps the messages spread by the media about the need for perfect, healthy aging don’t help us internalize that, inevitably, the years leave their mark on the body. In The Era of Diagnosis (Ariel Publishing), Dr. O’Sullivan speaks about all of this with a lucid perspective that truly makes one think.
We should perhaps internalize that aging healthily does not mean living without discomfort but learning to distinguish what is part of the body’s natural process from what truly requires medical attention. And, as many healthcare professionals say, over the last few decades a kind of “health hypervigilance” has spread — a culture that turns any symptom, fatigue, or change in the body into a possible illness. It’s not that preventive interventions or reasonable screenings shouldn’t be done — absolutely not! It’s just that sometimes too much medicine can also kill. Medical technology — which thankfully keeps improving — routine checkups, and the promise of a life without pain or decline have all contributed to making everyday discomfort —a cough, fragmented sleep, an occasional lapse of memory— seem like an alarm signal. The result is a spiral of scans, diagnoses, and medications that, far from guaranteeing more health, often generate more anxiety and more risk.
“I’d rather live fully until I’m eighty than reach one hundred taking a million pills,” O’Sullivan told me in a recent interview. Her warning is not against science or medical progress, but against a drift that confuses prevention with obsession. In her practice, the doctor has seen patients of all ages —including older adults— come in distressed after a battery of tests that don’t explain their symptoms but leave them with the suspicion that they are ill. “We value youth so highly,” she said, “that we have unrealistic expectations about the changes that come with age.”
In developed countries, overdiagnosis and polypharmacy —which we’ve already discussed in this blog— have become a problem. According to data from the Spanish Ministry of Health, more than 50% of people over 65 regularly take five or more medications, and 20% take as many as ten or more different active ingredients every day. Let’s not forget that each pill adds possible interactions, side effects, and costs, without there always being a periodic review to assess whether they’re still necessary. And of course, it’s not about stopping medication when one’s health depends on it but about introducing more individualized review in each case.
Polypharmacy is not just a pharmacological problem — it also reflects the frequent excess of diagnoses. A British Medical Journal study titled Preventing Overdiagnosis: How to Stop Harming Healthy People already warned a decade ago that overdiagnosis —the identification of diseases that would never have caused symptoms or relevant harm— affects thousands of people. Screening with ever-shifting limits of what’s considered “normal” (as in the case of cholesterol or blood pressure) and the search for early disease in asymptomatic bodies have created a kind of medicine that detects more but doesn’t necessarily heal better. This was also explained in the book Overdiagnosed: Making People Sick in the Pursuit of Health (2012) by doctors Gilbert Welch, Lisa Schwartz, and Steve Woloshin.
In older adults, this phenomenon has a particular impact. The aging body shows variations that are, in many cases, natural adaptations, as O’Sullivan explained to me. Some examples: sleeping fewer hours, slower digestion, stiffness, or minor memory lapses are not always pathological signs. But when these changes are interpreted as failures, a chain reaction begins: one test leads to another; an incidental finding —a small spot, a kidney cyst, a mild arrhythmia— generates a diagnosis, and that diagnosis almost inevitably leads to a prescription. “The problem,” says the doctor, “is that we’ve stopped accepting what’s normal and what’s simply part of life.”
The paradox is that the intention to prevent can end up causing more harm. So-called “secondary prevention” —checkups, scans, imaging tests— saves lives when properly indicated but can have side effects when applied indiscriminately.
Let’s give an imaginary name to a case like those Dr. O’Sullivan describes in her book. María, a 74-year-old woman, goes to the doctor because of mild chest pain. An electrocardiogram shows a small irregularity. From there she goes for an MRI, then a catheterization. Everything turns out normal, but the process leaves her anxious and with preventive medication for blood pressure that she didn’t previously need. Two years later, she experiences dizziness from low blood pressure and takes another medication to counteract the first. Like her, thousands of people get trapped in this mechanism: tests that generate findings, and diagnoses that often lead to new treatments — which, in turn, create new symptoms.
The causes of this dynamic are diverse. One of them is the model of medical care based on speed and fragmentation, where family doctors must attend to multiple patients in just one hour. A report by the OECD shows that only 4% of medical appointments in Spain last 15 minutes or more — far below the 47% average across member countries, according to Redacción Médica. O’Sullivan pointed it out clearly in our conversation: “What really improves people’s health is time with a doctor who listens; when there’s no time, the quickest thing is to order a scan.” Family doctors —whom we see as the guardians of our overall health— are overwhelmed. In this context, technology becomes a substitute for the clinical conversation, and prescriptions replace accompaniment.
Another factor is social and media pressure. Health has become an ideal. And in that sense, older people, used to trusting medical authority, seek immediate answers for any symptom. But there’s also a culture that pushes them to do so: advertising campaigns, promises of eternal longevity… Preventive medicine, when it becomes a marketing tool, can easily turn into an industry of fear.
That’s why, in the face of all this, perhaps we need to recover a more sensible relationship with health: to accept imperfection, to live with change, to recognize limits without giving up care. To understand that the small changes we notice as we age are sometimes normal. Sometimes (not always, of course), caring for our health is not about adding, but about taking away: fewer pills, fewer tests, less fear. More time, more listening, and more acceptance of who we are — even as we grow older.
