Takeaway
To more accurately arrive at the diagnosis, it is generally wise to believe patients’ recounting of their symptoms and experiences. This can result in uncovering medical conditions that are sometimes labeled as being more generalized—like anxiety—and lead to improved patient outcomes.
Connecting with Patients | February 24, 2025 | 2 min read
By Michael Albert, MD, Johns Hopkins Medicine
“I’m so frustrated. I think that doctors believe I don’t feel well because I’m anxious, but I still think something is really wrong!” This patient sat in front of me for a new patient consultation, visibly nervous about how she was feeling, and clearly unsure if I’d be able to help.
In preparing for the visit, I saw that she’d recently been prescribed anxiolytics, and had no additional steps planned in her extensive medical workup outside our medical system. It would have been reasonable to attribute her extended course of vague abdominal pain, nausea, and weight loss to anxiety, and reinforce her prior treatment plan.
Instead, I approached with a multipronged plan:
1. Validate patient emotions.
Anyone who’s been on the receiving end of medical uncertainty can attest to how stressful it can be. Everyone expresses stress differently. Convey empathy for how the patient feels, and ensure they know it’s safe to share frustration and to verbalize symptoms.
2. Deliberately work on building trust.
In this encounter, I listened and then said, “I believe what you’re telling me. No one would deliberately choose to experience how you’re feeling.” Those words gave the patient confidence she could share her story without fear of judgment or shame. Over the course of that visit and subsequent conversations, I was able to tease out the nuances in her history that suggested further testing and a subsequent diagnosis.
3. Start with a clean slate.
Making assumptions based on prior clinicians’ histories and medical decision-making can lead to confirmation bias. Patients will appreciate, and deserve, a fresh approach.
4. Use basic diagnostic skills we learned in medical school.
Build a broad differential diagnosis list. In primary care, I’ve rarely encountered a “mystery syndrome” where everything on a reasonable differential list had already been considered. Particularly after patients have self-referred to specialists, whose focus is very deep, but understandably limited, primary care physicians bring tremendous value to a broad diagnostic workup that spans systems.
As it turned out, in the subsequent months, I was fortunate to find this patient had a rarely encountered, somewhat complex syndrome. This diagnosis was made easier by the extensive workup done prior to my assuming her care. Her anxiety was an understandable reaction to her symptoms, the uncertainty related to her condition, and the stress of feeling she wouldn’t get better.
Identifying elusive diagnoses is thrilling in the moment. And helping patients feel better, even when there isn’t a new diagnosis, can make us feel joyful and replenishes gratitude for our profession.
This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.