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

1. RCDr. Rangan Chatterjee0:00

   You've been seeing patients for over three decades now, and in your brand-new book, you're making the case that medicine may have gone too far. We may be over-diagnosing people, but also potentially turning basic human struggles and differences into disease.

2. SODr Suzanne O'Sullivan0:20

   Mm.

3. RCDr. Rangan Chatterjee0:20

   What's going on?

4. SODr Suzanne O'Sullivan0:21

   Yeah, so, you know, I think we've had a problem in the past perhaps with kind of under-diagnosis and neglect. So if you say, think about special learning problems like autism or ADHD, I mean, I was a, a school student in the '70s and '80s. Nobody was recognized as having special educational needs then. In my class of 120, there must have been people. So we've kind of, we've neglected young people who perhaps could have done better with, um, a bit of support. Maybe people with mental health problems were afraid to come forward. Also, people were going through doctors with too late with diseases like diabetes and things. So we realized we had a bit of a problem that we needed to correct, and we've been gradually trying to correct that. My fear is that as we have sought out more and more patients with these sorts of conditions, that we might have over-corrected now. We may be detecting and treating people that we don't really need to treat.

5. RCDr. Rangan Chatterjee1:16

   Yeah. I mean, I guess there's all kinds of conditions, aren't there, that are rapidly on the rise?

6. SODr Suzanne O'Sullivan1:21

   Mm.

7. RCDr. Rangan Chatterjee1:21

   I mean, I think at the moment, is it one in five people in the UK have some sort of mental health disorder?

8. SODr Suzanne O'Sullivan1:28

   Yeah.

9. RCDr. Rangan Chatterjee1:28

   I mean, that's a lot of people, right?

10. SODr Suzanne O'Sullivan1:30

    It's an absolutely astonishing statistic, and you have to really start asking, "Well, what's going wrong?" Because if it's true to say that one in five people has a mental health problem, then, you know, potentially something is going extremely wrong in the world. My question, however, is, are we sadder, or are we attributing more to mental health disorders? And I think that's the key question, is, um, are we actually becoming more unhappy, or are we medicalizing what would usu- we would in the past have called ordinary unhappiness? And that, and that's kind of my focus of, of The Age of Diagnosis, is to think about what I call over-diagnosis, and I wanna kinda clear up what that is at the very start.

11. RCDr. Rangan Chatterjee2:09

    Yeah.

12. SODr Suzanne O'Sullivan2:09

    Because I think it's sort of, you know, people hear politicians talk about over-diagnosis, and they immediately jump to this conclusion, "Oh, you're saying that there's nothing wrong with us. We've been diagnosed, but it's wrong, and we're fine." That is not what over-diagnosis is. Over-diagnosis means that somebody could potentially have, um, significant struggles, but the question is whether medicalizing those struggles is the correct thing to do. And I guess I'm worried now that this one in five people who are said to have mental health problems are having genuine struggles medicalised when perhaps maybe social change or some different sort of support would, would help them more than a medical label.

13. RCDr. Rangan Chatterjee2:51

    It's interesting. A- as I read through your book, I think, "Wow, this is so well-written." Um, there's a deep compassion behind your words, but you're actually trying to raise awareness of something-

14. SODr Suzanne O'Sullivan3:04

    Mm

15. RCDr. Rangan Chatterjee3:04

    ... that is critically, critically important.

16. SODr Suzanne O'Sullivan3:08

    Mm.

17. RCDr. Rangan Chatterjee3:08

    And as you say, you're not saying that, you know, y- you're not saying that certain conditions don't exist. You're absolutely not saying that. And one of the, one of the key questions you, you ask is, is the diagnosis helping you? Not is the diagnosis-

18. SODr Suzanne O'Sullivan3:22

    Yeah

19. RCDr. Rangan Chatterjee3:22

    ... right. Is the diagnosis helping you? Why might a diagnosis not help us?

20. SODr Suzanne O'Sullivan3:28

    So when I write a book, I'm writing it for my patients, you know, in a sense. I don't know if any of them read it, but I'm writing it to address things that happen in my clinical practice that I'm not comfortable with. So I start this book with a story of two people, a patient of mine, um, who I'm calling Stephanie, and her daughter, Abigail. So Stephanie was a lady who I've been looking after with epilepsy for nearly two decades now. Um, she came to me with unexplained seizures. We discovered she had epilepsy. I'd been treating her for many years, and I, I haven't been making her much better. Seizures aren't responding to treatment. But in the course of these couple of decades, I discovered that she also had a progressive difficulty with walking. Now, I couldn't find out why she had epilepsy. I couldn't find out why she had difficulty walking. And then one day, her husband made a chance remark that kind of made it all so much more clear. He said that their 15-year-old daughter, Abigail, who was not a patient of mine or of anyone's, ha- was teased in school for having a funny walk, and he said that she walked exactly like Stephanie. Now, I mean, you're a doctor. You know that's the, one of those moments where you think, "Oh, my God," you know, "there is the clue that I have been waiting for that will tell me, um, what might be wrong with Stephanie." So it immediately sent them for, to a genetics clinic, both Stephanie and Abigail, Abigail at the time was only 15, um, to investigate the possibility they had a genetic condition. It took a while to get there, but that is what they had. Now, this is sort of really an issue which, the... First of all, that's a diagnosis that in a sense, as a doctor, I could be celebrated for. You know, I had found a rare diagnosis that was hard to find. I had done for Abigail what people kind of are telling me I should do, which is predict diagnosis ahead of time so people are empowered, um, anticipate future health conditions so they can be addressed as soon as symptoms start. You know, it, it should, in a way, be a success story for my practice as a doctor, but I actually came away from that experience feeling incredibly guilty, um, and just thinking, "What, what did I do?" Because if I looked at it another way, you know, I'd taken a 15-year-old girl who was, um, you know, she, she had some gait problems, some walking problem, but it was so subtle, she didn't, it didn't bother her. She was good at yoga, and she wasn't good at running. That suited her fine.

21. RCDr. Rangan Chatterjee5:48

    Mm.

22. SODr Suzanne O'Sullivan5:49

    And I pretty much said to her, "I think you have a potentially neurodegenerative problem. Now I'm gonna send you for tests." I turned a girl who believed she was healthy into a patient. And I, this for me in this book is the really important... point about overdiagnosis is overdiagnosis doesn't mean the diagnosis was wrong. I had found something wrong with Abigail, but h- what favor had I done her really? You know, she could have quite happily waited another 10 to 15 years f- for her life to be medicalised. You know, it could be that, um, I could have changed the whole course of her life by telling her that she had this problem. You know, I could have made her feel that her body wasn't healthy or wasn't normal. I could have f- forced her to worry about the walking that she wasn't worried about. And I think this is really the whole point about diagnosis is diagnosis should come along to solve a problem, and it should lead somewhere. But if we're increasingly giving healthy people diagnoses to anticipate futures that might never happen or kind of burdening people with diagnoses 10 years before it's necessary, then are we really doing the right thing for those people?

23. RCDr. Rangan Chatterjee6:59

    Yeah. You brought up so many interesting points there, that you would be celebrated and are celebrated as a doctor for making that diagnosis.

24. SODr Suzanne O'Sullivan7:11

    Mm.

25. RCDr. Rangan Chatterjee7:11

    And I was thinking about this this morning. You know, I was reflecting on your book, and, and a lot of the concepts in it are kind of things that I've intuitively felt in medicine since I've practiced actually.

26. SODr Suzanne O'Sullivan7:22

    Mm.

27. RCDr. Rangan Chatterjee7:22

    I've always struggled with giving people labels.

28. SODr Suzanne O'Sullivan7:25

    Mm-hmm.

29. RCDr. Rangan Chatterjee7:25

    Like, I always have. I can see it so clearly now. It always felt wrong or, can I say, limiting to me-

30. SODr Suzanne O'Sullivan7:33

    Mm

Episode duration: 1:43:08