A SECOND OPINION
This space is for our physician members to speak their minds freely on both medical or non-medical issues of the day and respond to the opinions of others . The GLMS Editorial Board reserves the right to choose what will be published . Please note that the views expressed in A Second Opinion or any other article in this publication are not those of the Greater Louisville Medical Society or Louisville Medicine .
Nope !
by MARY BARRY , MD equanimity and persuasion .
Sometimes the Ayes have it , and sometimes the Nays . If you have ever had the pleasure of watching Question Time in the House of Commons , you have seen the Prime Minister face both vociferous attacks and applause , ideally with equal amounts of
When a doctor faces a patient who presents with an already diagnosed ailment – but the doctor can find no trace of that ailment – finding such equanimity can be difficult .
Sometimes the patient will describe a rash that rings no bells in the doctor ’ s mind . Sometimes the patient will suffer faintness or nausea or fatigue or other subjective miseries that the doctor cannot slot into a pattern . Sometimes the patient describes phenomena that frankly boggle the mind . I knew a very nice but very sad lady , decades ago in the mountains of Tennessee , when I was only the free clinic chauffeur and not even the aide . We went back and forth there weekly in my 1963 Dodge Dart , often backing down the steeply winding roads so a massive coal truck could pass . She was a pro lookout in this dicey maneuver , comforting me greatly . Over the summer she got progressively better : breathed better , felt better , lost lots of water weight . She cheered up .
Yet she complained to me of “ polka dot ” knees . I said , “ Do you mean like when you kneel on them a good while and they get red ?” No . “ You mean like bug bites ?” No . “ Did you fall on them and hurt them ?” No . “ Are you rolling up your stockings too tight ?” No . “ Are they scars , like carbuncles ?” She did not know what those were , and I did not know the mountain term . I was out of ideas , especially when she said what really bothered her was that they came in different colors – pink and purple and green .
In the Grady ER , I would first learn about factitious disorder , when people seek psychological gratification from medical attention to symptoms or signs they make up , or harm themselves to produce . This is a serious mental health issue that requires careful diagnostic evaluation and significant , ongoing , lengthy psychiatric consultation . It can escalate to ever more dangerous behaviors , frightening everyone who cares for and about the patient . My lady did not fit this description : she was a nice , helpful sort . I later wondered if she had color-vision issues , or was simply odd , or was pulling my leg the whole time and I was too innocent to catch on . She sounded nothing like the very troubled and worrisome people whom I would encounter later in life , who swallowed things and vomited profusely and suffered , badly , in a chamber of horrors of their own .
Yet another classification of the non-diagnosis is the wrong diagnosis . The patient is not a zebra : the doctor has backed the wrong horse . Early on , I encountered a young veteran ( I ’ ll call him Earl ) who was convinced he ’ d had a seizure . It had messed up his life . He was not driving and not working , and he had been medically discharged . He was pretty much sulking and drinking
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