“Doc, I’m not sick. All I need are some days off work. I’m tired.”

I am willing to wager my left almond that every medical doctor who has spent any reasonable amount of time in a private consultation setup has heard the statement above, if not verbatim.

Dear colleagues, please note that I have deliberately made my assertion very generic because I still have a profound affinity with my gonads. I am well aware there are a few grinches that patients find unapproachable. Please do not send Urologists to collect payment merely because no patient ever asked you that endearing favour.

Anyway…

How do I approach such a request, you may ask? Well, I unambiguously do my job. I make a diagnosis.

The Medical field has become so advanced that there are now medical terms for what used to be called “laziness” or “avoiding being an adult”. A thorough perusal of the International Classification of Diseases Tenth Revision (ICD-10) will reveal a buffet of billable conditions that medically justify absenteeism. I call this fascinating bunch of conditions “free diseases”.

At this point, it would be prudent to clarify that Depression and Anxiety are not “free diseases”. Better still, I will now briefly sermonise on these common conditions.

Affective Disorders

Depression and Anxiety fall under a class of Psychiatric conditions called ‘Mood Disorders’ or ‘Affective Disorders’. The commonly romanticised Bipolar Affective Disorder (or manic-depression) also falls under this class.

In a broad sense, Affective Disorders are a cluster of conditions in which one’s emotions cause an identifiable negative effect on one’s functionality. These conditions are far more common than most people realise. For example, according to the World Health Organisation (WHO), approximately 5% of all adults suffer from Depression.

Ladies and gentlemen, when it comes to Mental Health, more definitely needs to be done.

Some of the statistics, in themselves, induce Depression. For example, we all know that Depression can lead to suicide. In fact, among young people in the 15 to 29-year age group, suicide is ranked fourth as a cause of death. Yet, 75% of people with psychological disorders in low- and middle-income countries go untreated.

By their nature, Psychological conditions are tough to identify and own up to. That is why some patients with Depression, Anxiety or other forms of Affective Disorder can present to the doctor’s office with nothing but, “Doc, I’m not sick. All I need are some days off work. I’m tired.” I never take such patients for granted. I probe further and make a diagnosis.

Making a Psychiatric Diagnosis 

There is no objective measure of Psychiatric symptoms. In other words, one cannot claim, “This patient has ten grams of irritability”, “That patient has twelve millilitres of sadness”, or “This patient had seven centimetres of worry”.

The definition of a Psychiatric Disorder is arrived at through consensus. The custodians of this onerous responsibility are the American Psychiatric Association (APA). These experts incessantly forage through all the research and other global developments and publish their recommendations. The latest of these is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), published in March 2022.

To use Major Depressive Disorder as an illustration, the DSM-5-TR stipulates that five or more symptoms (from a given list of ten) should be present for at least two weeks. Four additional criteria also have to be fulfilled. Just a few days of feeling low are not enough to diagnose one with Depression.

Lastly, it is crucial to note that some physical conditions can manifest as psychological symptoms. A worthy example is Hypothyroidism (low thyroid gland function) which may present with nothing but depressive symptoms.

ICD-10 and “Free Diseases”

On the other hand, sometimes people need a break from work. Some workplaces harbour ‘energy vampires’. These are toxic individuals who suck all the life out of you. We all know the type. If you do not know them, then maybe it is you.

The ICD-10 can assist in such a scenario.

The ICD-10 is a medical classification system developed by the WHO for statistical purposes. However, health financial systems also use it to guide the billing of services. For example, a doctor may apply the ICD-10 Code Z56.4 (Discord with boss and workmates) as a diagnosis to grant you a few days off work to allow you to cool off.

There are many such “free diseases” within ICD-10. A few interesting examples are Z60.4 (Social exclusion and rejection), Z60.2 (Living alone), Z56.3 (Stressful work schedule) and R53.8 (Other malaise and fatigue).

Be it as it may, if you do not feel like going to work, please drop in on your doctor and tell them everything. Take care of your mental health. 

DO NOT SUFFER IN SILENCE.