Worked example 1
Maya, 34, visits her GP monthly with new bodily complaints (headaches, chest tightness, fatigue). Tests consistently show no pathology, but she insists something is seriously wrong and has seen three specialists in six months.
(a) Identify two forms of health service misuse illustrated here. [2 marks] (b) Explain one psychological explanation for Maya's behaviour. [3 marks] (c) Evaluate limitations of labelling this behaviour as 'misuse'. [5 marks]
Show solution outline
(a) Forms of misuse:
- Illness anxiety disorder (hypochondriasis) — persistent belief in serious illness despite negative tests.
- Doctor shopping — consulting multiple specialists seeking confirmation of feared diagnosis.
(b) Psychological explanation — cognitive:
- Maya may catastrophically misinterpret normal bodily sensations (headache, fatigue) as evidence of life-threatening illness.
- Selective attention to bodily symptoms and confirmation bias — remembering test anomalies, dismissing reassurance.
- Health Belief Model: high perceived threat (severity) but low perceived benefits of reassurance — so she continues seeking medical confirmation.
(c) Evaluation:
- Strengths of 'misuse' label: Identifies resource drain and distinguishes from malingering (external gain).
- Limitations:
- Stigmatising — patient experiences genuine distress; 'misuse' implies deliberate waste rather than psychological suffering.
- Rosenhan parallel: Medical system may pathologise normal help-seeking; staff frustration can worsen patient anxiety.
- Reductionist: Ignores social factors — past medical trauma, family illness history, or inadequate GP consultation time.
- Cultural variation: Somatisation of distress is normative in some cultures — Western biomedical model may misclassify.
Judgement: Useful framework for service planning, but clinicians should treat underlying anxiety with CBT rather than repeatedly dismissing concerns.