HYPOCHONDRIACS

I had my share of patients who were hypochondriacs. They usually start by pin pointing  a lot of pains and aches on their bodies . I usually don't know where to start. If a patient does not follow the protocol that we learned in medical school, we will be at a lost.  For example, a patient complains of headache that radiates to the foot, it does not follow any disease algorithm. Either he has a problem in the head or he has a problem in the foot. Two diseases are plaguing the patient. If he adds another symptom, for instance, pain the neck, this will add to the confusion. What if there are 10 pain areas that he is complaining, we will get crazy and this makes us think that the patient is a hypochondriac and he ills a lot.  Because we are not in the position to argue and tell the patient to follow the protocol ( of course), we ask him to undergo a lot of diagnostics. When the results come in and they are all normal, most the time, this will add more to the paranoia of the patient. The question they usually post is why are all his lab results normal when he can feel a lot of pains. When we start telling the patient that he never had any problem, this will lead to a severe exchange of words leading to quarrels and confusion.
I have not fallen to this problem again after I decided to face a hypochondriac patient head on. The moment I can sense that his history is going nowhere, I usually deliver my cards face-up and tell him that nothing is wrong with him.