When It's All in Their Heads
Three physician bloggers discuss how to treat patients with imagined ailments.
Hypochondria deserves as much respect as any other ailment, these physician-bloggers say, because there’s underlying anxiety at work.
No Relief From Worry
Adapted from a March 1, 2013, post on the blog of Albert Fuchs, an internist in Beverly Hills.
Every primary care doctor has been faced with this situation: A patient reports vague symptoms and is very worried that they are a sign of a catastrophic illness.
What can the doctor do? One option is to order a test, whatever would rule out the disease the patient is worried about and maybe even lead to the resolution of the symptoms by letting the patient focus on something else.
But ordering a test just to reassure a patient doesn’t actually reassure the patient. It might be more effective to take the time to understand the cause of the anxiety. Testing patients who are almost certainly healthy raises the possibility of false positives because of test errors.
Doctors need to learn to say to patients, “That doesn’t sound worrisome. Let’s just keep an eye on it,” without being dismissive.
Hear Them Out
Adapted from an Oct. 9, 2013, post on Zackary Sholem Berger, the eponymous blog of an evidence-based-medicine physician at Johns Hopkins.
There’s one question I get asked a lot: “I research my health problems on the Internet. Am I a hypochondriac?”
We should ban that word when talking about ourselves. No one wants to be called that. Everyone has some range of complaints and worries in life, often physical and mental together, and this is our job as doctors: to hear them out. I firmly believe that no complaint is illegitimate.
Nor do I know of evidence that seeking health information on the Internet increases worry, another common concern mentioned to me.
In Need of a New Definition
Adapted from an April 11, 2013, post on The Binscombe Doctor Blog, composed by English physician Martin Brunet.
I should say what I mean by hypochondria; it is easier to start with what it is not. It is not someone who worries a bit more than most about their health. Most important, hypochondria does not refer to illness that cannot be explained by doctors—medically unexplained symptoms are common, while hypochondria is rare and quite specific.
A true hypochondriac is worried that he or she is unwell. The illness is often focused on one fixed belief—a lump in the throat becomes a cancer, abdominal cramps can only be explained by a bowel infestation.
The challenge with hypochondria is to help someone move from focusing on physical symptoms to an understanding of the nature of their anxiety. Hypochondria as a diagnostic label is now beyond rehabilitation, but the word still exists in our popular vocabulary, and we should treat it with respect, because it will continue to represent the experience of real people with real lives.