YOUR SYMPTOMS: SAY WHAT YOU MEAN
His problem was persistent daily headaches that had begun the previous winter as soon as the weather turned cold. At about that time, this 37-year-old systems analyst had taken a faster-paced, better-paying job that he hoped would enable him to buy a home and replace the 20-year-old jalopy he had to drive an hour each way to and from work. After a workup that included a referral to a neurologist, CT scans and MRls of his head and neck, and a complete laboratory survey, his doctors decided the long commute and increased job stress were causing tension headaches. But Valium and several muscle relaxants didn’t help. Some well-meaning friends suggested he get psychiatric help. He remained miserable.
When I questioned him closely, I learned that his headaches waned noticeably several hours after he arrived at work and returned soon after he got home in the evening, yet they never bothered him on weekends. Those details gave me a hunch. I asked him to drive straight to my office after work one evening. He arrived with a splitting headache. A blood test showed an elevated level of carboxy hemoglobin, an indicator of carbon-monoxide poisoning. He got rid of that car so fast that we never found out the source of the exhaust leak that nearly cost him his life. His headaches disappeared just as fast.
Communicate your condition
For many people, the notion of modem medical diagnosis conjures up images of assorted high-tech tests, computer analyses, and complex imaging equipment. All these tools do help enormously in diagnosing disease, yet none is more important than the patient’s ability to explain his or her case to the doctor. Inadequately expressed symptoms can lead even good physicians down the garden path to misdiagnosis. If you do your part by communicating your symptoms accurately and forcefully, your doctor stands the best chance of getting to the bottom of your problem. Here’s how:
• Get the timeline right. Take along a written list of all of your complaints and do your best to list them in chronological order. Knowing which symptoms came first can often be the decisive factor in arriving at a workable diagnosis-as it was with the sys-tems analyst’s headaches.
• Get down to business quickly. Time-stressed doctors have a tendency to narrow down the list of possible diagnoses fairly quickly after an office visit begins. You need to make your concerns known at the outset before your physician jumps to what may turn out to be an erroneous conclusion.
• Be specific. Instead of complaining vaguely about pain, rate it on a scale of zero to ten (with ten being the worst). Describe the quality of the pain. Is it dull and aching as with tooth pain? Does your chest feel on fire, as with heartburn? Does the pain sting like an insect bite? Or is it a painful pressure, as if an elephant were sitting on your chest? Does the pain radiate or spread into adjacent areas? How long has it hurt, and how often does it hurt? Do changes in your position, exercise, sexual activity, or emotional state affect the pain? Does anything make it feel better? Or worse?
• If you fear the worst, say so. If you dismiss abdominal pain as “probably just gas,” your doctor may be tempted to agree— even if you’re secretly worried about ovarian cancer. I once saw a patient who had undergone six months of psychiatric treatment for a presumed anxiety syndrome. Numerous tests seeking a physical cause for her lightheadedness, sweating, and shakiness had come up negative. Careful questioning revealed that her symptoms kicked in only when her heart skipped a beat or two. Once I reassured her that the occasional missed beats were normal, the symptoms disappeared.
• Practice full disclosure. Be sure to tell your physician about visits to other doctors or specialists. Different specialists, each scrutinizing seemingly unrelated symptoms, can miss the forest for the trees. A recent example is a 43-year-old woman who saw a cardiologist for her high blood pressure, an orthopedist for her backaches, an internist for her diabetes, and a neurologist for her headaches. It turned out that all those problems stemmed from a single cause—a pituitary tumor causing Cushing’s disease, an uncommon disorder that caused her adrenal glands to produce too much cortisol. That potentially fatal condition had gone undiagnosed—and untreated—for nearly five years because this patient had not discussed all her symptoms thoroughly with any one physician. When she finally got around to doing so, her combination of symptoms prompted appropriate testing—and an eventual cure.
Health handbook introducing you to read the article: HOW TO SPEAK UP TO YOUR DOCTOR
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