Picture a busy A&E department on a winter evening. Among the emergencies - heart attacks, broken bones, severe injuries - sits someone with a sore throat. Another with an ingrown toenail. Last winter in England, over 200,000 people turned up to emergency departments with complaints like these, leading many to ask: are people misusing A&E - or is something else going on?
Author
- Robin Bailey
Assistant professor, University of Cambridge
A perspective not always considered in this discussion is that the sore throat (or other seemingly minor ailment) isn't really the problem. The problem is the terror that it might be something worse. Unfortunately, the healthcare system has no idea how to address that fear.
The term for this fear is health anxiety . A person with health anxiety constantly worries that they might be sick or have a serious disease. It's accompanied by repeatedly checking the body for symptoms, obsessively searching online for explanations and constantly seeking reassurance - often from medical professionals.
Studies suggest that 3% of people in the general population and 20% of hospital out-patients struggle with health anxiety. And the trend appears to be moving in the wrong direction. A large international review found that health anxiety has increased over the past 30 years.
One catalyst for this trend could be the internet . Researchers call this aspect of health anxiety "cyberchondria" .
Studies find that people who worry a lot about their health tend to feel worse, not better, after searching for their symptoms, and that they are more likely to seek further reassurance from doctors and emergency departments.
A dry throat becomes a sign of a serious infection. A headache becomes a brain tumour. A rash becomes sepsis.
The more a person searches, the more alarming possibilities they find. The more alarming possibilities they find, the more urgently they seek reassurance.
Emergency departments are a natural destination for this problematic cycle. They offer rapid testing, expert authority and the promise of immediate safety.
For someone whose worry feels uncontrollable , waiting days for a routine appointment can feel like gambling with survival.
A 2025 study in Australia looked at 400 people who came to emergency care with non-urgent problems. Researchers found that people who worried most about their health were more likely to see symptoms as needing emergency attention, even when they did not.
This group also reported more emergency visits and more use of other health services over the previous six months. This suggests that worry itself, rather than the severity of the symptom, may be driving repeat visits.
Similar findings are emerging in the UK. A recent emergency department study found that severe health anxiety was common in patients well enough to walk into a hospital and was closely tied to how they interpreted and escalated symptoms.
The cost of fear
The cost of this cycle is not just emotional. A 2023 review pulled together studies from Europe and the US and estimated that untreated health anxiety costs healthcare systems between about US$857 (£644) and US$21,138 per person per year.
Although common and costly - and placing high demands on health services - health anxiety remains neglected in policy.
Although health anxiety is recognised by professionals as a real condition, the UK's National Institute for Health and Care Excellence and the American Psychiatric Association have not published specific guidelines on how doctors should treat it.
In a recent Lancet article , I argued for health anxiety to be treated with the same seriousness as other mental disorders, and for clear routes between physical and mental health services so that health anxiety does not simply keep cycling through clinics and emergency departments.
The absence of guidance leaves doctors in an awkward position. In emergency departments, staff are trained to rule out serious physical illness quickly. But when tests suggest low risk and a patient remains intensely frightened, there is no agreed-upon clinical approach for addressing the fear that brought them in.
A review of health anxiety in hospitals suggests that, without a consistent way to recognise and explain this problem, the encounter often ends with further investigation, brief reassurance or discharge.
These responses are understandable when staff are busy and under pressure, but they don't address the underlying anxiety and can lead to people coming back again and again.
A consistent approach would help doctors acknowledge someone's distress without making them more worried, explain what's happening in a clear way, and connect them to psychological support before a pattern of seeking emergency reassurance becomes established.
Researchers have begun to explore practical ways to do this.
The debate about minor ailments in emergency care is perhaps missing an important point. The issue is not always the symptom, but the meaning the symptom has become.
Until health anxiety is given the same clinical seriousness as other common disorders, emergency departments may continue to absorb a problem they were never designed to treat.
Robin Bailey does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
