Q: Dear Dr Neuman: I can be reasonably confident in my Dr’s diagnoses & advice most of the time, but there are times that I would worry about leaving out a bit of detail when they were asking my history, leading them to skip a test or not consider a certain diagnosis, or that they have missed a possibility altogether. This is more likely to happen when I present to my doctor with symptoms, he evaluates, then tells me it’s ok, even if it doesn’t go away (like palpitations and heart races, which really doesn’t fully go away). How can I gain confidence in the fact that Drs are likely to have considered a fuller range of conditions, without me asking him off a list? How exactly do doctors arrive at the conclusion that a symptom maybe unexplained, but not medically dangerous? Many thanks!
– Victoria K.
A: You are describing a practice that is typical of health anxiety. Patients go to doctors repeatedly but feel that somehow they have not given the doctor a full picture–and that if the doctor truly understood the exact dimensions of his/her symptoms, a different diagnosis might be made. Not only that, but a few days later, or weeks later, those symptoms have changed subtly, and the health worrier is inclined to return to the doctor with the thought that maybe this latest manifestation of the occult disease he/she suspects will make everything plain. An analogy of this process is someone telling the doctor (or someone else) that the distance between New York City and San Francisco is three thousand miles and then, after thinking about the matter more carefully, comes back with a correction: it is three thousand and four miles. In other words, the distinctions that health worriers make about their symptoms are not meaningful. Doctors are trained to ask the right questions–and further questions if more detail is required.
– Dr. Neuman