Bioethics Discussion Blog: "In Every New and Smart Disease, From Housemaid's Knee to Heart Disease, She Recognized the Symptoms as Her Own!"

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Sunday, January 13, 2008

"In Every New and Smart Disease, From Housemaid's Knee to Heart Disease, She Recognized the Symptoms as Her Own!"


One of the challenges facing a physician when first encountering a patient with multiple symptoms is to establish by history and later by physical examination whether a patient has one active disease which accounts for all the symptoms or whether the patient has two or more separate diseases. And finally there arises in the doctor’s mind the possibility of hypochondria, that the symptoms are derived not from a physical disease but from a fear disorder that some disease or diseases must be present and a later diagnosis of the disease by the doctor is anticipated. The patient has a symptom corresponding to that disease and will not accept the conclusion of the doctor that no disease actually can be found. The challenge with this diagnosis is how the doctor can maintain trust and confidence by the patient and how to provide support and initiate effective treatment. It is difficult to tell a patient and have a patient accept that it is an emotional illness that is present. Since physicians may not have full confidence in their assumption of hypochondria and in order to attempt to placate the patient and indeed the doctor’s own uncertainty, expensive and unnecessary tests may be ordered. Patients may argue that hypochondria is diagnosed in error too frequently and important diseases are missed or specific treatment for them is delayed.

Have any of my readers had a diagnosis of hypochondria made that turned out to be in error? If you have an interesting history, you might tell us here. No names please.

The first part of the poem “How Jack Found That Beans May Go Back on a Chap” by Guy Wetmore Carryl amusingly describes a lady that fits the topic of this thread. ..Maurice.

(ADDENDUM: Illustration by Honore Daumier for an edition of Moliere's "La Malade Imaginaire" ca 1850)

HOW JACK FOUND THAT BEANS MAY GO BACK ON A CHAP
by Guy Wetmore Carryl (1873-1904)

Without the slightest basis
For hypochondriasis
A widow had forebodings
which a cloud around her flung,
And with expression cynical
For half the day a clinical
Thermometer she held
beneath her tongue.

Whene’er she read the papers
She suffered from the vapors,
At every tale of malady
or accident she’d groan.
In every new and smart disease,
From housemaid’s knee to heart disease,
She recognized the symptoms
as her own!

She had a yearning chronic
To try each novel tonic,
Elixir, panacea, lotion,
opiate, and balm;
And from a homeopathist
Would change to an hydropathist,
And back again,
with stupefying calm!

The closets of her villa
Were full of sarsaparilla,
Ammonia, digitalis,
bronchial troches, soda mint,
Restoratives hirsutical,
And soaps to clean the cuticle,
And iodine, and
peptonoids, and lint.

She was nervous, cataleptic,
And anemic, and dispeptic:
Though not convinced of apoplexy,
yet she had her fears.
She dwelt with force fanatical
Upon a twinge rheumatical,
And said she had a
buzzing in her ears!...

2 Comments:

At Tuesday, January 29, 2008 10:37:00 PM, Anonymous RL said...

Really funny, how I wish there was an Odgen Nash in our collection. But also sad. Hundreds of women mustve suffered with the myth that (like a lethal reverse-hypochondria) they are not prone to heart problems and attacks. Now were older and wiser.
family health news

 
At Tuesday, January 29, 2008 11:12:00 PM, Blogger Maurice Bernstein, M.D. said...

RL, you certainly are correct. There has been female gender underdiagnosis of coronary artery disease. Unfortunately not until in recent years has there been recognition by physicians that this has occurred. Also, in the past, symptoms attributed to hysteria were gender bound to women. Of course, hysteria was likely the wrong diagnosis. ..Maurice.

 

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