Let’s banish the term “worried well”

If anyone should fall into the category of a “worried well” person, it is probably me. I don’t have any chronic conditions, I take zero medications, and I’ve maintained a normal body mass index (BMI) for as long as I can remember. For those not familiar, “worried well” has been used in our industry by journalists, doctors, and companies to refer to people who are healthy but extremely anxious. These people are also sometimes described as “quantified selfers,” because of the attention they pay to their healthcare information, whether it be from medical tests, scans, or wearables. 

I used to be ashamed to be a member of this so-called “worried well” community. But I’ve changed my tune on it. Some level of anxiety about health is actually a good thing. Where I’ve channeled that worry about the future state of my health into curiosity, and ultimately into action, I’ve improved my lifestyle and learned about diagnoses I didn’t even know I had. One recent example through this journey I’ve been on - I learned I have a condition called PCOS, and specifically the far less common “lean” kind, which is a hormonal disorder that impacts women. About 1 in 10 women have PCOS, and it’s just one of a long list of conditions that affect women that are also underdiagnosed. 

Information is power. I’m by no means a techno-optimist who believes that more data will solve all the problems in healthcare. But I also don’t believe the system today is set-up to support patients who want to stay healthy for as long as possible. Patients fall through the cracks all the time, and yet those who choose to advocate for themselves are often labeled as difficult or annoying. As I’ve spoken with physician friends, a new reality has emerged that there’s in fact a significant swath of patients who are extremely sick and under-engaged; a tiny swath of highly vocal patients that are far too engaged; and a bunch in the murky middle. These individuals in the middle want answers and they would opt into prevention if they could, but they feel that their doctors don’t have time for them or they’re afraid of the expense.  

To put a finer point on it, the patients are not the problem. The system is. And we should stop using language like “worried well” that demonizes the patient who is fighting an uphill battle largely on their own to stay healthy and ultimately bend the cost curve. When that happens, we all win. 

“The conventional medical system is strapped for time, prevention isn’t reimbursed, and often doctors aren’t trained to answer your questions when it comes to being proactive about your health, my friend Dr. Robin Berzin, who’s also the CEO of a functional medicine company called Parsley Health, shared by phone. “As a result, you feel dismissed. 

“Doctors will think about the immediate problem, we’re trained in the chief complaint,” added Robert Green, a physician scientist and medical geneticist. “In an outpatient ambulatory setting where literally - and my wife is a primary care - you’re under ridiculous pressure to see patients every 10 to 15 minutes, that is a pressure cooker. The incentives are poorly aligned.” 

Dr. Berzin made the point that there’s very few people who are genuinely so healthy they can’t benefit from some amount of time and attention to discuss their health. There aren’t that many people who are so “well” that any amount of concern for their health is a bad thing, particularly when you consider that more than 70% of American adults are overweight or obese, and 60% live with at least one chronic disease.

“We have a sick population and yet the medical community is resistant to people who want to do something about their illness,” she said. 

The rise of the shadow healthcare system 

One outcome of all this is that the more engaged patient populations are drawn to cash pay alternatives to using their insurance. More Americans than ever don’t have a family GP. Millennials are leveraging primary care less than any generation in history. For better or for worse, what seems to be filling the gap for these populations is telehealth and hybrid clinics, where patients can pay a cash price to see a doctor. Longevity and functional medicine clinics are also taking off, in part because they have a fresh branding spin on primary care that patients seem to resonate with. Based on the meteoric rise in services like Function Health, Lifeforce, Prenuvo, and more, people seem to like the idea of health optimization and extending their life span. 

“There are whole industries that have sprung up… because conventional medicine has done a not so great job at helping the individual manage their risk factors,” said Dr. Green. 

There may also be some downsides to the rise in cash-pay healthcare. Dr. Green acknowledged there are risks associated with people getting tests that scare them and getting unnecessary tests and procedures (“incidentalomas”), but he also said that studies could be designed to test whether or not this is actually a real concern. It’s entirely possible, in his view, that with the right coaching and counsel, patients won’t run screaming to the oncologist to check every mole for cancer or rush to get test after test they don’t need. 

But again, that kind of coaching and counsel requires time between providers and patients, which our existing healthcare system doesn’t have. So the natural conclusion to all this is that we’ve now ended up with two healthcare systems: One that is for cash buyers, and another that incorporates insurance. Rarely is there integration and continuity of care between the two. 

I’m also worried about growing inequities because of this. Cash pay healthcare can be affordable, but oftentimes it doesn’t come cheap. And it’s the individuals who could most use that hour-long sit down with a physician to discuss their health that can’t afford it. Everyone deserves access to high-quality healthcare. There are some positive signs of progress, particularly with a recent development that now allows people with high deductible health plans to pay for subscription-based healthcare services using pre-tax HSA dollars. As I argued in a recent column, that could be a big boost for making longevity services more affordable. 

My recent experience with the Prenuvo scan

One of the companies at the dead center of the debate about whether all this cash pay healthcare is for the “worried well” is Prenuvo. I can’t tell you how many conversations I’ve had with physician friends who expressed concerns that a whole body MRI scan, plus comprehensive bloodwork, would send patients into a tailspin. 

So when Prenuvo reached out to inquire about whether I would personally like to get the new AI-enhanced body scan, I immediately agreed. Amongst other things, a spokesperson for the company told me that Prenuvo tests for thyroid function, cardiovascular risks, immune health, pancreatic health, and spine health through a combination of the blood testing and the scan. 

For those curious about doing a whole MRI scan like this one, I would ask yourself if you’re claustrophobic. You do need to sit in a machine as still as possible for about an hour. I was able to endure it, even though I’m mildly claustrophobic. The time went by faster than I expected with a headset streaming Netflix. The bloodwork I did a few days prior at a lab near my house. 

If you’re interested in a full step-by-step review of the experience, let me know! But in the interim, I will say this. The most valuable part of it by far for me was the hour I spent with a doctor going through the results. What surprised me was how clear they were with me related to a finding that might cause me to be anxious - say, a thyroid nodule - but where they weren’t worried, and why. Again, I do believe that with the right coaching and time, patients can understand the level of risk. All in all, I walked away feeling that I’m doing a lot right. I was extremely healthy for my age group. But there were definitely areas of possible improvement, particularly related to some back pain I’d been experiencing that was linked to mild scoliosis and a slipped disc. 

Most of the physicians I spoke to about this experience seemed to think that the time was well spent, particularly once I shared my own interpretation of the results and thinking about lifestyle changes I might make going forward. 

 “I think some folks are rightfully good about getting preventive care in a systematic and thoughtful manner, and are good about listening to various perspectives and discussing with their physicians,” said Dr. Disha Narang, an endocrinologist and obesity specialist. 

Ultimately I think it comes down to the product being sold. Prenuvo seems expensive enough that the main product is the actual experience, and I was definitely encouraged to come back in a few years. What worries me more is where I see companies converting patients into ordering supplements from them or other products that aren’t evidence-based to juice profits. 

Misinformation is another big problem, and it’s definitely leading patients down some rabbit holes. Dr. Narang is concerned that some of these “wellness” companies may be tapping into some underlying anxiety in our society, driven in part through social media and an expectation of “100%” wellness that isn’t realistic. But most of the time, she noted that when patients experience symptoms, it’s multifactorial and there’s not a clear cut answer. It is worthy of further investigation, and no snake oil remedy is going to fix it overnight. 

Some regrets… and a rebrand 

I’ll admit that I have used the term “worried well” in the past while working as a journalist. I now regret it. But my perspective has changed as I’ve gotten older, and I’ve watched friends grapple with cancer diagnoses, chronic illnesses, long and traumatizing experiences related to infertility.

I’ve changed my tune to encourage the people in my life to get into their front seat when it comes to their own health. Life is too important and too short to not care about health, and invest in it accordingly. 

But I am also a firm believer in the idea that having a trusted, trained medical professional in the loop should be part of the process. ChatGPT can be a super helpful tool, and that hour I spent with the physician asking questions was where I got most of the value from the Prenuvo experience. Unfortunately, that often means expensive concierge medicine that’s not affordable for most people, although there might be rare cases out there where it’s possible with a family GP (those doctors are often working in their personal time to cater to patients in a system that rewards them for maximizing panel sizes). 

So I’m proposing we ditch the term “worried well” and instead refer to people who want to engage in prevention in a far more positive way? I don’t yet have a catchy marketing-friendly term,  but I love words like "vigilant" and “proactive.” I’m all ears if anyone out there has an alternative. 

Again, the system we have doesn’t make any of this easy. It is actually hard to stay healthy in America because of the lack of healthy food and so many other factors. It takes steady practice and constant attention. Dr. Berzin gives the example a lot in her own writing of ACOG recommending that women get bone density scans at 65. It’s her medical opinion that these should begin earlier and she’s now recommending women get DEXA scans younger. Bone density peaks at 28, she noted, and women lose about 20% of their bone mass in menopause. So there is no reason to wait. Mammograms are another good example. Many of the women I know who have been diagnosed with breast cancer didn’t find anything on a mammogram. A lot of them have dense breasts, and had to advocate for themselves to their doctors. There are countless examples like this where being vigilant pays off. 

“Let’s stop resisting the idea that the average person shouldn’t be in control of their own health,” said Dr. Berzin. “It’s a net good thing: good for society, good for the individual, and it bends the cost curve if patients stay healthy and avoid serious disease.”