7 Best Ways to Deal With a Hypochondriac Patient

Debra A. Shute

Disclosures

September 03, 2019

"Not making a big deal of it, but listing illness anxiety with just a couple of quick notes about what you're doing about it, is the best compromise," he says. "I tell patients that if another doctor takes that information and treats them badly because of it, we'll cross that bridge when we come to it."

5. Discuss the Patient's Fears

"The fundamental task for any anxiety is to learn to deal with uncertainty," says Gots. Illness anxiety disorder is actually a variant of obsessive-compulsive disorder, she says, and persons with the disorder typically feel compelled to seek constant reassurance about their health.

"They're looking for reassurance," she says. "But with this type of anxiety or any obsessional worry, even though it feels better when they get it, [reassurance] actually perpetuates the problem."

What these patient do need is to be heard. "These are people who are really scared," Gots says. "Listen and take their concerns seriously, but that doesn't necessarily mean running down every test."

Staab recommends asking patients to state their specific fears. "We often jump to conclusions about what people are afraid of, such as patients with cancer being afraid of dying," he says. "But they may be afraid of suffering, or of being a burden to their family, or of not seeing their children graduate."

6. Don't Surrender Patient Satisfaction

Although patients with illness anxiety are frequently unsettled about their health, they aren't inevitably unhappy with their care—especially when best practices are followed.

It is certainly possible to take care of patients with unexplained symptoms and illness anxiety and have satisfied people.

"It's not been my experience that patients with anxiety are more litigious than other patients," says Staab. "My practice has some of the highest patient satisfaction of our department. It is certainly possible to take care of patients with unexplained symptoms and illness anxiety and have satisfied people."

Patients are typically left feeling unsatisfied, on the other hand, when they feel that their clinician didn't listen or care about them. "The real threat, legally, from patients with illness anxiety is not that they have illness anxiety, but that they have illness anxiety and you didn't do anything about it," says Staab. "Then if something happens, the fact that they're at loggerheads with their physician can drive them to talk to a lawyer instead of their doctor."

7. Address Symptoms That Defy Diagnosis

The only time that symptoms are "made up" is when a patient is truly lying, says Staab. "Malingering sometimes happens, but that is a different problem," he says.

On the other hand, missed medical diagnoses are a real concern for physicians. When caring for patients who have symptoms that defy medical diagnosis, Staab tells them that he will follow their symptoms with their primary care clinician and that one of three things will happen:

  • The symptoms will go away, in which case they will remain a mystery but won't be a problem.

  • The symptoms may stay the same, in which case he, the primary care physician, and the patient will collaborate to find a way to deal with them.

  • The symptoms will get worse or change, in which case clinicians will have the opportunity to evaluate them again.

"My diagnosis of illness anxiety disorder does not depend on other physicians' work but on whether I detect the core features of the condition," Staab notes. "The fallacy of being able to 'rule out everything medical' is why the concept of illness anxiety replaced hypochondriasis."

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