The New York Times
February 28, 2006
Cases

Doctors Take Note: Even the Whiners Sometimes Get Sick
By ANNE MARIE VALINOTI, M.D.

A colleague in the medical practice where I work asked me about a
patient she was seeing.

"I'm concerned about Mrs. B's abdominal pain," she said. "She looks
very uncomfortable, and she's usually so stoic."

This is a code phrase in medicine. The stoic patient rarely complains.
The stoic patient never makes office visits for trivial matters. The
stoic patient's symptoms are to be taken seriously.

And so, Mrs. B. was sent for an urgent CT scan of the abdomen and had
her inflamed appendix taken out later that day. After years of
stoicism, Mrs. B. earned her reward: her doctor didn't question the
severity of her symptoms and her illness was diagnosed and treated
promptly.

But what of the less-than-stoic patient? What about the people who come
to the doctor for every ache, sniffle or bump? Healthy people with
charts thick from frequent visits for minor symptoms they believe to be
fatal?

These are the people who can tolerate a bit less discomfort or
uncertainty than the average person. These are the patients who cry
wolf. The only trouble is, sometimes there really is a wolf. The
challenge for the doctor is knowing when. I learned this first hand
when I took care of Robert.

Robert was a young man who first came to me complaining of a sore
throat. A pleasant man in his 30's, he was very distressed about his
symptoms. To me it seemed he was healthy but suffering from a mild
viral illness; there were no signs or symptoms of anything serious.

I told him his sore throat would resolve. Sure enough, in two days he
was much better.

Robert was my patient over the next several years. Once or twice a year
he would come in with a sore throat, and he often complained
dramatically about it. I would prescribe Tylenol and gargles and it
would get better.

During the time I took care of him, he also developed diabetes, which
he never took as seriously as his sore throats, despite my nagging at
him to diet, exercise and take his medication.

One winter day I got a message to call him regarding "a severe sore
throat."

As usual, there was much moaning and groaning from him over the phone.
Despite my advice to wait it out a few days he called again the
following day.

"This guy is such a wimp," I thought. More advice from me regarding
tea, honey, gargles and the like.

On the third morning, Robert's girlfriend called me. "Robert had a
terrible night. He looks awful," she said.

I sighed.

"O.K., throw him in a cab, and I'll look at him in the office now."

How annoying to have to overbook my busy morning with this nonsense.

Or so I thought. The minute I saw him in the exam room I realized that
this was not the usual sore throat. He flopped on the exam table and
lay there, lethargic, breathing rapidly and hardly able to speak.

One look in his mouth told the whole story. His entire throat and oral
cavity were covered with a thick yellow coat. It was thrush, the fungal
infection that can be a sign of out-of-control diabetes. This, along
with his altered mental status and rapid breathing were signs of
diabetic ketoacidosis, a potentially fatal complication of diabetes.
Robert's wolf was finally here.

I had him admitted to the hospital, where he stayed for a week,
including several days in the intensive care unit. If he had not come
to see me when he did he might have died.

Thankfully, he made a full recovery. And he taught me a lesson I'll
never forget: even the wimps get sick.

http://www.nytimes.com/2006/02/28/health/28case.html?_r=1&oref=login

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