Thursday, 19 July 2012

YOUR HEALTH Dr James Le Fanu: 20 July

Are older people taking drugs they don’t need? Hearing your own heartbeat, and why perfectionism can be bad for your health

Written by Dr James Le Fanu
Hypertension, as we all know, can be hazardous, predisposing to heart attacks and strokes that are obviously best avoided. It is thus all to the good that family doctors should make a habit of measuring their patients' blood pressure and prescribing appropriate treatment if it is raised.

Recently, however, the screening for such hidden ailments has gone seriously awry, with many people being told they are afflicted with illnesses they do not have and coerced into taking drugs they do not need. Here, the experience of a lady from Preston is most revealing. She is now in her early 80s, widowed but gratefully still healthy and independent.

'For the past few months my general practitioner has been trying to persuade me I am not as fit as I think I am,' she writes. She has learnt, following a barrage of blood tests, that she has 'borderline diabetes' (her sugar level being at the upper end of the normal range); that she must take cholesterollowering drugs (her cholesterol is normal but being supposedly diabetic – apparently – it is a matter of 'the lower the better'); and that she has 'mild hypertension', which also requires treatment.

The cause of this lady's plight is that her family doctor no longer perceives her, as he should, as a person to whom he has 'a duty of care'. Rather she has become a means to an end – 'reaching the target' of numbers diagnosed with diabetes and being treated with cholesterol and blood pressure lowering drugs on which his remuneration is now calculated.

Senior citizens such as this lady are particularly vulnerable to being targeted in this way as these 'physiological variables' of blood pressure and cholesterol tend to rise with age, and so many will fall just beyond the arbitrary cut-off point that warrants treatment. Thus, for example, while a cholesterol level of, say, 7.5 might warrant treatment in a middle-aged man with a history of heart trouble, it would be completely normal for a fit person in their 70s or beyond.

The best and indeed only way of dealing with this regrettable trend is to know what is going on and those who feel they have been pressurised into taking drugs they do not need should consider discontinuing them.

This week's medical problem comes courtesy of a woman from Bath who has recently started hearing her heartbeat in her left ear, sometimes with an added 'squeaky' sound. Her family doctor is unable to find anything amiss and having just turned 70 she wonders whether this might simply be 'one of the inconveniences of getting older'.

This 'heartbeat in the ear' is known as pulsatile tinnitus and is usually caused by increased blood flow to the middle ear or changes in 'awareness' of that blood flow, which is amplified in those with glue ear. When, however, there is no obvious underlying explanation, then referral to an ENT surgeon is appropriate, for some form of imaging as occasionally a dilation or aneurysm of the blood vessels may be responsible.




Perfectionism is in general a highly commendable character trait – and certainly those content with the shoddy and second-rate usually have low self-esteem. Still, as chartered psychologist Jenny King points out in the BMJ, there is also an 'unhealthy' form of perfectionism that can have serious adverse consequences.

The warning signs include, she suggests, 'all-or-nothing thinking' (as in 'no one understands how important this is'); failure to delegate; inability to forgive oneself or others for mistakes; procrastination to avoid the possibility of error – and dissatisfaction with success.

These attributes can have a disastrous effect on working relationships and, Dr King maintains, need to be promptly identified and dealt with appropriately by, for example, cognitive behavioural therapy.

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