7 Best Ways to Deal With a Hypochondriac Patient

Debra A. Shute

Disclosures

September 03, 2019

Meanwhile, physicians must be very clear to patients that they don't believe their symptoms are imagined, adds Lynne S. Gots, PhD, a licensed psychologist and assistant clinical professor of psychology and behavioral science at the George Washington University School of Medicine. "Very often, patients will go to the doctor because they felt a swollen lymph node and think they have leukemia. Instead of saying, 'That's nothing,' the doctor should explain why it's not a concern and when they'll check on it again," she says.

2. Schedule Time to Address Concerns

It is reasonable and helpful to provide health-anxious patients with a structure within which to keep on top of their symptoms and concerns, experts agree. "It's a good idea to do it on a schedule rather than in response to anxiety," Gots says, "so that you're not inadvertently reinforcing the anxiety."

For example, Staab recommends scheduling regular appointments, such as every 3 or 6 months, to address all of the nonurgent concerns the patient has accumulated in that period.

"I'll tell patients, 'I'm going to keep track of all the things that you send me and put them in your record. If you send me things that lead me to think there's something we have to do in between appointments, then I'll arrange for that to happen. If you send me things that don't suggest any new or different medical problems, we'll go over your worries when I see you,'" Staab says.

[Patients] don't need to be seen because they have unstable blood pressure. They need to be seen because they're suffering from illness anxiety.

Although some may argue that such patients don't need to be seen for this type of visit, Staab says that's the wrong way of thinking. "They don't need to be seen because they have unstable blood pressure. They need to be seen because they're suffering from illness anxiety," he says.

Physicians may also worry that by giving patients a degree of extra attention, they'll continue to push for more. "Even in the most extreme cases, that limit has worked for me," Staab says. "Patients will adapt to it. It allows patients to say what's on their mind and the physician practice to keep tabs on it but not have to respond immediately to everything."

It's also important to set limits for patients on personal behaviors that feed their anxiety, Gots says. "I give people guidelines—and number one is not giving in to the compulsion to go on the Internet," she says. The problem with Internet research, she explains, is that patients tend to search out improbable disorders, without the medical knowledge to make an evaluation, and get even more upset. If patients want to learn more about their conditions, the resources should be approved by the clinician.

In some cases, Gots will advise patients to not perform various self-exams or look in the mirror. "If someone [with illness anxiety] feels a lump in their breast, they'll be palpating and palpating to the point that it becomes sore, and then the soreness alarms them."

For patients driven to check their pulse or temperature constantly, Gots has outlawed those behaviors as well, she says.

3. Don't Diagnose by Ruling Out

Anxiety itself can cause an array of physical symptoms, such as headache, dizziness, and shortness of breath, that overlap with those of other serious diseases, such as cancer or heart failure, which can seem a vexing problem for physicians. According to Staab, the real problem is with the traditional approach whereby physicians attempt to reach a diagnosis by ruling others out, he says.

"We've been taught to rule this out, rule that out, and what's left is psychogenic. That is fundamentally flawed. We have to get into a rule-in mentality," Staab says. "For example, if I find evidence for asthma and for anxiety, I have two problems. And my job is to optimize treatment for those two problems," he says.

At Staab's Mayo Clinic practice, the shift to ruling-in "has been the single most useful in improving the comfort that our patients have in dealing with uncertainty and worry about illness," he says.

4. Document the Presence of Illness Anxiety

To treat illness anxiety, it must be part of the problem list in a patient's medical record, says Staab. He acknowledges, however, that patients may have potentially valid concerns that other clinicians who see them won't take their concerns seriously.

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