Worried sick: What can doctors do about hypochondria?

Although the cause of hypochondriacal patients' pain is inexplicable, it presents a real challenge to primary care physicians.

By Susan J. Landers, AMNews staff. Jan. 24, 2005.

They can try the patience of even the most calm, cool and collected physician with ongoing complaints of a headache that is certainly a brain tumor or an aching arm that signifies bone cancer. No degree of assurances to the contrary can diminish their fears. Ultimately, addressing their needs poses a considerable and time-consuming clinical challenge.

Mastering the care of them, however, is also a priority for primary care physicians, because the number of these patients is great -- on average, as many as one out of 20 sitting in waiting rooms across the country at any given moment is a hypochondriac.

"Every physician has a thousand examples," said Robert D. Gillette, MD, a family physician, now semiretired, who works outside of Youngstown, Ohio. "The only question is whether you recognize it and know what to do about it or do you just kind of blow it off."

Ignoring such patients is a technique that has been employed by many. But Dr. Gillette and others have come to understand that dismissing such patients can lead to more trouble down the road for themselves, their patients and the other physicians to whom the patients will inevitably turn. In fact, he decided years ago that a sign he saw on a plumbing shop wall applied to their care: If you can't find the time to do it right, how will you find time to do it over?

"If you have a patient like this and you don't deal with it adequately, you are going to keep seeing the patient over and over again until they go somewhere else. Whereas if you can deal with it effectively, it takes a little longer up front, but it saves time in the long run," he said.