Patient: “Doc, I’ve got this nagging discomfort around my eyes. Nothing I do seems to help. What would you suggest?”
Dr. Brasco: “Fuggedaboutit.”
As an article in this morning’s Wall Street Journal suggests, a surprising number of patients are afflicted with so-called mystery medical symptoms. These symptoms come under the rubric of pain or discomfort, and of the three depicted in this graphic, two are common complaints among patients with undetected or untreated vision disorders: headaches and dizziness.
The gist of the article is interesting, and the presumption is that at the primary care level patients should be reassured that their aches and pains are merely a normal part of life’s events. This has to be done by the doctor in a believable manner, otherwise placating or hyper-paternalizing the patient can fuel hypochondriasis, now referred to as health anxiety. That is, of course, once appropriate tests have been run to rule out more serious disorders – serious being a code word for severe impairment or death. So what’s a doctor to do with a patient with ostensibly unexplainable symptoms who keeps insisting that something is wrong?
On the one hand the doctor might encourage the patient to keep a symptom diary. That however focuses even more attention to the nagging constellation of symptoms. Now there is Cognitive Behavioral Therapy, a more sophisticated way of talking patients out of their symptoms. Doctors can advise patients to be cautious about the accuracy of information discovered by researching signs and symptoms on the internet independently. Such information can frighten the patient into thinking that there really is something wrong that the doctor is overlooking or trivializing – for example, discomfort or performance problems that may benefit from interventions that aren’t yet within the doctor’s belief systems. Go figure.
In any event, the article is a good read, and the embedded audio a good listen. Then again, I got this information through the internet …