Hypochondriacs get ill too

By BBC Doctor Colin Thomas

As a new doctor when you first take over a list of patients it takes a while to get a feel for what your patients are all about.

When you have very little idea of their medical track record you take them at face value, but when you get to know them better you tend to piece this information in with the rest of the diagnostic jigsaw.

For example with the benefit of my previous knowledge of the medical behaviour of a patient who I was asked to see as an emergency 'having a heart attack', I was soon able to reassure them that they had only pulled a muscle.

I had just taken over in a practice, and I remember seeing a gentleman for the first time with symptoms that sounded quite serious.

Not only was I new, but he had recently moved in to the area and, as quite often happens, his clinical notes were 'in transit' between practices.

I did some investigations which all turned out to be normal, and I reassured him.

However the next week he turned up with a further set of symptoms, and I started to wonder whether he was a bit of a hypochondriac.

Constant worrier

This pattern persisted, and when I finally received his notes it was clear that in the past he had been a constant worrier about his health.

At one consultation the torture he put himself through really showed.

He explained that he had woken up in bed one night and felt a warm damp patch around his bottom.

He quite incorrectly imagined that this moist substance was blood and that he was bleeding uncontrollably from his back passage.

He was so scared that he didn't dare turn the light on to check, and resigned himself to his fate, as in his mind he gradually bled to death.

He lay there absolutely petrified for what he thought was about an hour as he waited for the inevitable, but eventually sleep took him over.

When he woke up the next morning firstly he was surprised to be still alive, and secondly he discovered that the moist sheet was due to his youngest son who had climbed into bed with him.

So it was nothing more than a wee problem.

Constantly tired

Over the next few months he attended with similar trivial problems, but on one occasion he complained of feeling tired all the time.

It would have been very easy to dismiss this as another hypochondriacal thought, but on closer questioning it was clear that he was drinking excessively and passing lots of urine.

When I tested his urine it was full of sugar and so this time he really did have something wrong with him - diabetes.

Much to my amazement, he took the news very well. I had expected that a hypochondriac might fall apart at the seams.

Later he confided that now he really had something to be concerned about all his other health worries had taken a back seat.

In essence he was ill, but he was also cured!