Thursday, December 11, 2008

A Beautiful Mind (2)

Ya. The unlucky me again.
Saw this patient who came in the midnight.

"Hello uncle, any problem?"

"Hmm. My problem is, I don't even know what's my problem!"

(*swallowed saliva* I know I'm in trouble, deep one)

"You see, I always feel like I have fever but actually I don't."

"I like to put one hot towel on my forehead, but if you ask me whether I have headache, actually not really. Why is it like that ah doc?"

(HOW am I supposed to know why you like to put hot towel on your head?)

"Then on and off my right hand will shiver. It happens more when the weather is cold, but sometimes when it's not so cold, it shivers a bit also."

"Then I also feel discomfort over my abdomen. No if you ask me whether it's pain, actually not really. Endoscopy? Ya I've done it. Even colonoscopy also. All normal."

"Sometimes I feel anxious. My job? Oh I work as a teacher. Stressful at times but strictly speaking, not to a level to cause me anxiety. Thyroid problem? Oh I just went for a complete health screening, all blood tests are normal!"

"My appetite is fine. Not much of weight changes recently also. But I on and off will feel tired also...you know? Like not interested to do things..."

"My symptoms sound like neurological symptoms? Ya one of my doc friends told me also. I've already gone for a brain scan and it's normal too."

"So doc, actually what's my problem?"

The whole consultation took me 30 min. And I think I sweated. The problem is not about the diagnosis, but difficulty in getting even the symptoms! Can you get a distinct symptom from his history? All also quite vague...and when you think of something and he'll tell you, "Oh I went for checking already and it's normal."

Tough isn't it? Any brilliant diagnosis other than "A beautiful mind"? ;)


Read also:
A Beautiful Mind (1)

15 comments:

Darren Lee said...

Actually the diagnosis could be somatoform disorder. But I don't think patient will like this diagnosis...

ding said...

or hypochondriasis?!
since he went thru sooooooooooo many unnecessary Ix... huhuhu!!!

Michelle Mak said...

lol....
dat fella got mental prob or not one??
midnight come for all this...should try arh...tell him uncle since u are not sure hor..i think i would like to admit u into ICU fr further investigation..or better still send u to forensic cut u up and see if their is any abnormalities...lol....

*mich runs off*

Zzzyun said...

yah i was thinking of the somatization of his thoughts in aches here n thr..

but true, the patient probably wont like it... >.<

confessions of a medical student said...

but people with hypochondriasis seriously are disturbed by their illness and to them, it's so true.. it's a chronic course with remissions.. hmm... perhaps a psy-referral and lots of reassurance can be helpful? ^^

ccc said...

Aha, I guess it is usually difficult to label patient "mindset problem" upon first encounter at the casualty but this particular person is too... too much to being attended even at the green zone.

Another misuse of ER. These people should be seen at clinic la.

peanut said...

munchausen!!!! hahhahaa... i think he brighten up ur day gua.. if such things happen, is it obligated to put a diagnosis no matter how ah.

Yuen said...

hmmmm, sure sounds like somatoform disorders to me too. I just wondered if he has ever been referred to psychiatry, considering he has been through one shotgun of an investigation (which I don't like the sound of them), with allegedly normal results.

How old was he? How long has he had those vague Sx? PMHx? Any Hx of depression? Any stressors in his life atm? =\

Darren Lee said...

I had a few patients whom I suspected to have psychosis/ depression/ anxiety disorders that I would like to refer psychiatry - their responses are usually denial or refusal. Some even get furious and told that, "You psychotic also I not yet psychotic!"

The problem is, mentioning the sentence "i think you should see a psychiatrist" is a very taboo thing in our society!

nila said...

Neurasthenia?

nila said...

since psy is a taboo...
maybe can try placebo effect....
give a simple diagnosis and prescribe some vitamins... =p
but dunno if ethics allows us to try tat....

ccc said...

Well, you need not tell them "seeing a psy/mental doc", maybe just say "Life's tough and stressful nowadays, you seems very worried amd amxious anout... I think you need some help, there are experts out there who understands more and could offer more... some friendly chat might make you feel better (psychotherapy)..." ;P

Darren Lee said...

nila: Ya i think symptomatic treatment might work..but just for temporary..then they'll be back..

ccc: Trust me I tried that! I only told them that i'd refer them to a "specialist".

Later the pt came back and almost (luckily not) threw the letter on me, "You referred me to a psychiatrist? You think I'm crazy?!! I'm smarter than you ah I tell you!!...#$%%^@@"

Since that, I think I got phobia dy..sigh=p

joan said...

haha... i think this patient definitely need a psy opinion... anxiety disorder, mild one.. he wont be satisfied with somatoform disorder... :P s/times i feel bad for u working in A&E n seeing this kind of patient.

Darren Lee said...

Joan: Thnx..tat's y, this type of patients should be seen in clinic not emergency department ler..somemore that night he came at such an odd time..

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