On-demand healthcare and medical apps may increase health anxiety
On-demand healthcare may increase the instances of health anxiety, also known as somatic symptom disorder and illness anxiety disorder. Having telemedical applications on hand through smartphones may contribute to an increase in the disorders, which affect up to 12% of the population. The regular and easy access to medical professionals has led to app makers having to take ethical decisions about suggesting a referral for therapy for the disorders, should they arise. Such anxiety sufferers are likely to be the ones making the most use of the apps and providing significant revenue, thus creating an ethical dilemma.
Because they are so easy to use, some medical experts wonder whether, over time, telemedicine apps will encounter a disproportionate number of users with health anxiety disorders. Already, app makers are encountering the ethical question of whether they should encourage such users to seek mental help.

MDLive’s chief medical affairs officer, Deborah Mulligan, says that the company’s app has 28 million registered users, and it’s likely that about 6 percent have this condition, which mirrors the proportion found in the general population. What makes matters more complex is that with any other type of mobile technology, these people would be considered “super users” who drive revenue—the kinds of folks you want to stick around and keep using the app all the time.

Mulligan spent much of her career working in emergency rooms and was trained to recognize the symptoms of health-related anxiety disorders, which include worrying about a disease when there are no symptoms, experiencing high anxiety about minor aches and pains, and not feeling reassured by negative test results. She recalls one MDLive patient who exhibited all of these symptoms, and who suggested setting up regular consults to discuss a specific health condition that the patient didn’t have. After several sessions to build up trust, Mulligan recommended that the patient try MDLive’s cognitive behavioral therapy service.

“They contacted me to thank me,” she says. “It was like a weight off their shoulders.”

Doctor on Demand board member Bob Kocher says that the majority of people who use the app are calling up about routine symptoms, like colds and the flu. He isn’t aware of patients with health-related anxiety regularly using the app to discuss their symptoms. However, he thinks it’s possible that more such patients will discover the app as it gains mainstream recognition.

“Frankly, I think there are some of these patients in the health system who haven’t found us yet,” he says. “I’m sure we’ll have board meetings someday about a patient who used us 20 times that week.”

Kocher says that app makers might make a “lot of money” through these interactions but will have a responsibility to investigate whether the cases were handled well.

One of the challenges of finding these kinds of users, experts say, is the lack of information transparency, particularly as the apps don’t share data with each other. “We don’t really know who the frequent users are,” says John Torous, co-director of the digital psychiatry program at Beth Israel Deaconess Medical Center. “It’s a population that is not well characterized.”

And Doctor on Demand’s chief medical officer, Ian Tong, points out that excessive health anxiety might be challenging to monitor if patients use an array of different apps.

“You might not be able to tell unless the person was being prescribed a lot of medications,” he admits.