Inside The Minds

example, a new patient presented to me with complaints of

headaches, memory loss, shortness of breath, paresthesias,
migratory body aches, fatigue, and lightheadedness. She had
already been evaluated by several other physicians and had
undergone extensive and expensive diagnostic testing; yet no
diagnosis had been made and no therapy offered. After a long
conversation with the patient, we were able to identify her sense
of being overwhelmed by a recent move to New York because of
her husband’s job change, the recent birth of her first child, and
some marital strain. She was actually relieved by the diagnosis
of depression and somatization and responded quickly to
appropriate antidepressant medication and behavioral therapy.

The art of medicine can also be demonstrated in the effective

handling of a patient’s phone question. Even without examining
the patient, a working diagnosis can often be entertained if one
knows which initial and subsequent questions to ask and if one
not only listens to, but successfully understands the patient’s
replies. Recently a patient telephoned because of a rash. By
questioning the patient about the color, size, pattern, and location
of the rash and of associated paresthesias, I suspected the patient
had Varicella Zoster. The patient came in to my office, and
appropriate antiviral therapy was initiated. Similarly, a patient
might page a doctor at night with the complaint of chest pain.
Only a good doctor could relatively accurately distinguish
musculoskeletal pain (which could be treated with anti-
inflammatory medication and evaluated the next day) from more
serious processes, such as pulmonary embolism or ischemia
(which would require immediate emergency room evaluation).

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