Early in my career, a woman came into my office bent over in pain. She leaned on the exam table. "I know it's all in my head," she apologized. "It's just my usual back pain. This time I can hardly stand it."
We docs are trained to avoid using gut instincts to make a diagnosis. We learn a list of illnesses that might cause each symptom. For back pain, that lengthy list includes kidney stones. We checked her urine. Sure enough, she had one.
With our own symptoms, we can get more jumpy. Like many doctors, I've run blood tests on myself, checked my own urine, and performed countless self-examinations to understand symptoms when they pop up. So when patients tell me they think they're being hypochondriacs, I usually confess that I am one too.
And why not?
"Hypochondriac" is a ten-dollar word, probably coined by some well-educated person—perhaps a physician. It's derogatory. All it really means is that the doctor can't solve the patient's problems.
True, hypochondria can be harmful when someone uses their symptoms to avoid life's challenges: "I have depression, so I can't achieve this or that."
We docs need to forestall those harmful conclusions. We need to remind people that a medical diagnosis, such as depression, is often provisional. If correct, we provide treatment and they improve. If not, we need to fix them in some other way or shut up. Our diagnosis isn't helping. Maybe they're grieving, trapped in a hopeless situation, avoiding a spiritual problem, have an undiagnosed physical illness, a medication side-effect, exposure to some toxin—you name it.
If we cling to an unhelpful diagnosis, they may think, "Well, the doctor says I'm depressed but can't treat it, so it's hopeless." In my medical courtroom, taking away hope is malpractice.
Healthy hypochondria is simply self-attention. We are trying to use our symptoms to guide us toward a better understanding of our health and how our bodies work.
And making sure that funny looking thing on my arm isn't a melanoma!