282 Interacting with Their Patients
Increased Sensitivity to Symptoms
Ill physicians may now be able to diagnose symptoms better in others,
having confronted these symptoms themselves. Certain symptoms (e.g.,
pain, nausea, insomnia, anxiety, and depression) constitute inherently
ineffable subjective states, and are difficult to quantify objectively or
convey verbally. Those who have experienced them acquire a distinct,
though not unalloyed, advantage. Psychiatric symptoms pose particular
problems, as ill physicians may run the risk of overdiagnosing them. For
example, Suzanne now overestimated bipolar disorder because she some-
times overidentified, though ‘‘I try to really notice that.’’
Yet one’s own experience of illness can increase awareness of the
difficulties of diagnosing subtle evidence or absence of disease symptoms
in others. For instance, Suzanne could detect individuals who tried to
deceive doctors, claiming to have psychiatric disorders in order to obtain
secondary gains.
I am good at smelling out if a patient is really psychotic or ma-
lingering. When someone comes to the ER, I can really tell if
they’re lying. Either I really know what it’s like to be mentally ill,
and can tell that they’re just not; or I am really good at identify-
ing if somebody is manic versus on cocaine. One guy said he was
just a mess, an emotional wreck. But then he went to sign some-
thing, and was ok: got the pen and pulled it together, no prob-
lem. If somebody says they’re hearing voices or are really paranoid,
or seeing things, you just watch where their eyes go, listen to
the way they talk. . . . You get a hunch. A lot has to do with re-
latedness. When you’re sick, you’re ‘‘off.’’ There is a sort of ‘‘off-
ness’’ about you. Three times, patients were going to kill me when
I told them they couldn’t get admitted. I knew they were bull-
shitting me. They’d get up and say, ‘‘You fucking bitch, I wasn’t
going to kill anybody, but I just wanted to. . . .’’ We have a
park nearby, and they do crack, then come in here for a good
night’s sleep.
Suzanne also now better distinguished between early mania and anx-
iety. She used a metaphor of smelling diagnoses to suggest how her
awareness increased of the subtle, and indescribable aspects of deter-
mining diagnoses, involving additional vaguer, and more nuanced kinds
of information than many doctors use.