Why is it so hard to accept the diagnosis of “Asthma” ?
When a patient goes to a doctor with his problem, the doctor will do an examination and perform certain test and reach a diagnosis. The doctor will say ” You have malaria ” or ” You have diabetes .” This pronouncement is distressing, but it is not dis believable.
But many a times when a diagnosis of asthma is made, the patient would find it hard to believe that he/she actually has asthma. What is it about asthma that patients find it difficult to accept it ?
There are many reasons behind this. It makes an interesting analysis. Let us look at the reasons closely.
- Acute vs. chronic diseases. Malaria is an acute disease. It comes and it goes. It can be cured. Asthma, diabetes and high blood pressure are chronic diseases. They are there forever. The patient has to live with it. Therefore psychologically it is harder to accept this reality.
- Diagnosis is not cast in iron. Many diseases have very clear cut signs and symptoms which make the diagnosis apparent even to lay people. For eg. shaking chills and rigors of malaria, passing too much urine in diabetes or body aches in dengue. Moreover, diagnostic tests for many diseases are quite conclusive. For instance “your blood sugar is 240 mg. % or your platelets are only 40 thousand.” There can be no ambiguity.In asthma we do not have the luxury of that kind of certainty. The signs and symptoms are varied in different patients. Some patients will have all the classical symptoms of chest tightness, cough, difficulty in breathing and wheeze. Some patients may have cough as the only symptom of asthma. Moreover, there is no single test which confirms the diagnosis of asthma ( unlike diabetes where blood sugar levels clearly define the diagnosis). In asthma, tests of blood, sputum and lung function clearly point towards a diagnosis of asthma and an experienced doctor can be reasonably sure of the diagnosis. But for the patient there can be room for doubt.
- A natural disinclination to accept that you have a chronic disease. It is human nature to deny, for as long as is possible, that there is something wrong with the body. And if that person generally takes good care of herself ( for eg. If she exercises regularly or does yoga ); then the thinking process is in the line of – ” I take so much care of my health, how can I get asthma “”
- Diagnosis in children. When a doctor is seeing a child who wheezes, even the doctor cannot be sure if this is really the beginning stage of asthma or it is a temporary wheeze due to a viral infection. Only passage of time will clarify the issue.
- Waxing and waning nature of asthma. Asthma is not equally severe all the time. In some seasons it is really bad and in others it is quite under control. Moreover, in some cases it can go into long periods of remission. When that happens, the patient naturally feels she is “cured”. The truth is that the “tendency for asthma” is always there and it can, and often does, re appear later in life.
- Social stigma attached to it. This used to be a big deal earlier; just as it was with tuberculosis or epilepsy. The younger generation of today accepts it more easily.
So what is the harm if the patient does not accept the diagnosis ? Denial only leads to treatment not being taken. The air tubes remain inflamed and constricted and this leads to irreversible changes and damage. Over the years asthma becomes permanently irreversible.