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Doctor SPEAKS OUT: "They're Quietly Labeling You Sick—Even When You're Not" | Suzanne O'Sullivan

VIVOBAREFOOT is sponsoring today's show. To get 20% OFF YOUR FIRST ORDER visit: https://bit.ly/3FLdvBa AG1 is sponsoring today's show. To get 1 year's FREE VITAMIN D and 5 FREE TRAVEL PACKS visit: https://bit.ly/43FwxQl Order MAKE CHANGE THAT LASTS. US & Canada version https://amzn.to/3RyO3SL UK version US https://amzn.to/4iPjdjl Could our healthcare system be making us sicker rather than healthier? In the UK, autism diagnoses have increased by a staggering 787% between 1998 and 2018, and one in five people now has some form of mental health disorder. But what if some of our health struggles aren't diseases to be cured, but normal human experiences being medicalised? This week, I'm joined by Dr Suzanne O'Sullivan, a consultant in clinical neurophysiology and neurology at The National Hospital for Neurology and Neurosurgery, who specialises in the investigation of complex epilepsy and also has an active interest in psychogenic disorders. Her latest book, The Age of Diagnosis: Sickness, Health, and Why Medicine Has Gone Too Far, aims to challenge long-held assumptions about medical progress and change the way we think about our health. In this thought-provoking conversation, we explore: • Why giving someone a diagnosis is never neutral – it can fundamentally change how a person views themselves, their body and their future possibilities • How the definition of autism has dramatically expanded over the past few decades from its original concept of "extreme autistic aloneness" to now potentially including 1 in 20 children in Northern Ireland • Why screening for diseases like prostate cancer can lead to unnecessary treatment • The potential problems of genetic testing - when results are misinterpreted or used without proper context, especially with tests that aren't clinical grade • Why early detection and treatment aren't always better, particularly when it turns healthy people into patients decades before they might develop symptoms • The profound story of how Suzanne diagnosed a rare genetic condition in a 15-year-old girl, only to question whether she had actually done the right thing by medicalising someone who believed herself to be healthy This is a nuanced, compassionate discussion that challenges many of the widely held assumptions in modern healthcare and I would urge you to listen with an open mind. Throughout our conversation, Suzanne emphasises that she's not arguing against the existence of these conditions or suggesting everyone should refuse diagnosis. Rather, she encourages both patients and doctors to consider whether medicalising our struggles is always the right approach. I hope you enjoy listening. #feelbetterlivemore ----- Suzanne’s books: The Age of Diagnosis: Sickness, Health, and Why Modern Medicine Has Gone Too Far US https://amzn.to/4lZXesG UK https://amzn.to/434gAo7 It's All in Your Head: Stories from the Frontline of Psychosomatic Illness US https://amzn.to/433aqnY UK https://amzn.to/4m8WYIe The Sleeping Beauties: And Other Stories of Mystery Illness US https://amzn.to/4iPjdjl UK https://amzn.to/4k2LLH1 Brainstorm: Detective Stories From the World of Neurology US https://amzn.to/4iSu63L UK https://amzn.to/4m3J7mi #feelbetterlivemore #feelbetterlivemorepodcast ------- Order MAKE CHANGE THAT LASTS. US & Canada version https://amzn.to/3RyO3SL, UK version https://amzn.to/3Kt5rUK ----- Follow Dr Chatterjee at: Website: https://drchatterjee.com/ Facebook: https://www.facebook.com/drchatterjee Twitter: https://twitter.com/drchatterjeeuk Instagram: https://www.instagram.com/drchatterjee/ Newsletter: https://drchatterjee.com/subscription DISCLAIMER: The content in the podcast and on this webpage is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

Dr. Rangan ChatterjeehostDr Suzanne O'Sullivanguest
May 6, 20251h 43mWatch on YouTube ↗

At a glance

WHAT IT’S REALLY ABOUT

How modern medicine may over-diagnose, over-test, and reshape identity

  1. O’Sullivan distinguishes over-diagnosis from “wrong diagnosis,” arguing the core issue is whether medicalizing a struggle actually helps the person or simply burdens them with a patient identity.
  2. Through cases like a teenager labeled with a rare neurogenetic condition and a woman fearing Huntington’s disease, the conversation highlights how belief and attention can amplify symptoms (nocebo/labeling effects).
  3. They critique a “test-first” culture—scans, biomarkers, and screening—where incidental findings and broadened thresholds (e.g., blood pressure, pre-diabetes) can convert large populations into worried patients.
  4. The discussion explores controversial areas (autism/ADHD, cancer screening, POTS, long COVID communities) where labels may provide validation and support for some but reduce self-efficacy and expectations for others, especially children.
  5. Both emphasize “good medicine” as slower, relationship-based care—listening, follow-up, and clinical judgment—alongside a renewed role for generalists to counter harms from hyper-specialization and polypharmacy.

IDEAS WORTH REMEMBERING

5 ideas

A diagnosis can be true and still be harmful.

O’Sullivan’s story of diagnosing 15-year-old Abigail with a rare neurodegenerative mutation shows that “finding something” may not help if there’s no treatment and the label changes how a healthy person experiences their body and future.

Labels change physiology indirectly by changing attention and interpretation.

The Huntington’s story (Valentina) illustrates how expecting illness can make ordinary lapses—tripping, airport stress—feel like evidence of decline, escalating anxiety and symptoms until the threatening interpretation is removed.

More testing creates more “abnormalities,” not necessarily more health.

Incidental findings on imaging (back scans, X-rays read as “arthritis”) and screening-detected abnormalities can trigger cascades of follow-up, worry, and treatment even when findings would never have caused harm.

Lowering thresholds medicalizes huge groups for small marginal gains.

They argue that expanding categories like borderline hypertension or pre-diabetes may prevent some events, but at the cost of turning many low-risk people into long-term patients—psychologically, financially (insurance), and medically (side effects).

Screening can save lives and still over-treat many others.

O’Sullivan cites screening trade-offs (e.g., breast cancer: many screened to save one life while more undergo unnecessary treatment) and stresses informed consent plus options like watchful waiting when appropriate.

WORDS WORTH SAVING

5 quotes

Over-diagnosis doesn't mean the diagnosis was wrong. I had found something wrong with Abigail, but h- what favor had I done her really?

— Dr Suzanne O'Sullivan

I turned a girl who believed she was healthy into a patient.

— Dr Suzanne O'Sullivan

A diagnosis is not inert. It's not just something that comes with positives or neu- is neutral. It comes with negatives.

— Dr Suzanne O'Sullivan

Once you learn you have a disease, you can't unlearn it.

— Dr Suzanne O'Sullivan

I think we should be targeting people with multiple risk factors because we know that they're the high risk group, rather than targeting a whole population, including lots of people who have no other risk factors.

— Dr Suzanne O'Sullivan

Over-diagnosis vs misdiagnosisLabeling/nocebo effects and symptom amplificationGenetic testing and predictive medicine (Huntington’s, BRCA, APOE4)Cancer screening trade-offs (breast, prostate, over-treatment)Expanding diagnostic thresholds (hypertension, pre-diabetes)Autism spectrum expansion, identity, and school accommodationsHyper-specialization, fragmented care, and polypharmacyDirect-to-consumer genetics and family-wide consequencesIllness identity vs recovery identity (long COVID example)What “good medicine” looks like: listening, time, watchful waiting

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