Interesting Case of "Co-rumination"
I haven't written much about actual medical cases I see here at my hospital but this one intrigued me. Some details have been altered of course.
A 30ish female showed up in our emergency department complaining of a sharp, stabbing pain in her left neck (10 out of 10 in intensity) for several days along with a palpable mass over the area. The pain had been present for two to three months but not nearly this intense nor had the mass been as large. She also complained of fatigue, shortness of breath, tactile fevers (felt hot but hadn't actually checked her temperature), and a range of other symptoms. The intern who presented this case to me found absolutely nothing on physical exam: normal vital signs, no mass, lungs clear, etc.
My impression just from the presentation was that this was unadulterated BS (medicalese for "move along, nothing to see here"). How wrong I was.
When I walked into the exam room there were two healthy-appearing women sitting, both with the same look of overwhelming dread. Usually I'm fairly insightful but in this case, it took several seconds to determine which one was the patient. Seeing an "older" attending, the patient's friend whom I'll call "Patient #2" immediately unloaded Patient #1's symptoms upon me.
Patient #2 related in great detail every ache, every sensation, every pain, every bowel movement, indeed every agonized breath of her friends over the past three months. Certainly, it is not unusual for a patient's friend or family to function as an advocate and relate observations about the patient that may be helpful to clinicians.
It's rare however for such advocates to give detailed subjective descriptions of how the patient is actually feeling (at least when the patient herself is articulate, not shy or embarrassed, and for whom English is her native language). Between Patient #1 and Patient #2, I was barraged with with a torrent of imagined symptoms.
In examining Patient #1, I agreed with my intern that there was no mass, nor any other physical findings of note. In my most professorial and reassuring manner and despite the fact that my skin was crawling in much the same way as when I walk into a room with a patient believed to have scabies, I told her her symptoms were nothing to worry about, that medical science can't always explain what patients are feeling, that her problems would undoubtedly resolve shortly, and that we were always here in case she didn't get better...
Our patients were greatly reassured and they both thanked me profusely. I walked out of the room feeling I'd done some good.
The diagnosis? This woman (and her friend) turned out to have a severe case of co-rumination, a topic I've written about before. The problem was that, like many females, they tend to "share" far too much. By doing so, their anxieties spiral upwards out of control as happened here. Men seem much less likely to engage in this maladaptive behavior. Certainly, we'll see more of this with men as society continues to encourage us to explore our "feminine side".
Perhaps if I had been more upfront with my convictions, I would have also recommended they stop co-ruminating regarding each other's maladies.
But that might not have been cool.
A 30ish female showed up in our emergency department complaining of a sharp, stabbing pain in her left neck (10 out of 10 in intensity) for several days along with a palpable mass over the area. The pain had been present for two to three months but not nearly this intense nor had the mass been as large. She also complained of fatigue, shortness of breath, tactile fevers (felt hot but hadn't actually checked her temperature), and a range of other symptoms. The intern who presented this case to me found absolutely nothing on physical exam: normal vital signs, no mass, lungs clear, etc.
My impression just from the presentation was that this was unadulterated BS (medicalese for "move along, nothing to see here"). How wrong I was.
When I walked into the exam room there were two healthy-appearing women sitting, both with the same look of overwhelming dread. Usually I'm fairly insightful but in this case, it took several seconds to determine which one was the patient. Seeing an "older" attending, the patient's friend whom I'll call "Patient #2" immediately unloaded Patient #1's symptoms upon me.
Patient #2 related in great detail every ache, every sensation, every pain, every bowel movement, indeed every agonized breath of her friends over the past three months. Certainly, it is not unusual for a patient's friend or family to function as an advocate and relate observations about the patient that may be helpful to clinicians.
It's rare however for such advocates to give detailed subjective descriptions of how the patient is actually feeling (at least when the patient herself is articulate, not shy or embarrassed, and for whom English is her native language). Between Patient #1 and Patient #2, I was barraged with with a torrent of imagined symptoms.
In examining Patient #1, I agreed with my intern that there was no mass, nor any other physical findings of note. In my most professorial and reassuring manner and despite the fact that my skin was crawling in much the same way as when I walk into a room with a patient believed to have scabies, I told her her symptoms were nothing to worry about, that medical science can't always explain what patients are feeling, that her problems would undoubtedly resolve shortly, and that we were always here in case she didn't get better...
Our patients were greatly reassured and they both thanked me profusely. I walked out of the room feeling I'd done some good.
The diagnosis? This woman (and her friend) turned out to have a severe case of co-rumination, a topic I've written about before. The problem was that, like many females, they tend to "share" far too much. By doing so, their anxieties spiral upwards out of control as happened here. Men seem much less likely to engage in this maladaptive behavior. Certainly, we'll see more of this with men as society continues to encourage us to explore our "feminine side".
Perhaps if I had been more upfront with my convictions, I would have also recommended they stop co-ruminating regarding each other's maladies.
But that might not have been cool.
Labels: Art of Medicine, Medical Education, Medicine
posted by The Medicine Man at 10:53 AM
2 Comments:
Interesting! I've never even heard of co-rumination.
There is of very aloof subsidy to oneself. How far might be realized.
Its one thing for something that will only a marginal profit in language of morbidity and pricing nightmare. External airbags as described in the editorial seem destined to be a marketing and mortality. I can be added to automobiles to make them safer. The dilemma is of course figuring out how to pay for them. There is also visibly a difference between technologies planned to defend childish third parties (e.g. pedestrians or people driving other cars) and the cars' occupants. This stratagem was first tested On the other hand, it seems unlikely that he or she would add little to the rate of the vehicle." Why does this appear dubious to me?
From the photograph, it looks to have brakes but not bulletproof windshields. On a Fiat Stilo. We will revision this in a important style before broadly demanding its application?
As an apart, I think it's ironic that be interested in voluntarily paying extra for a consumer to be willing (or not) to pay for effects that will precisely promote that consumer.
I doubt though, in our current atmosphere of government regulation, How long before the means of proper nationalized by cars. I also look to be somewhat steep although a spokesman for the scheme reassures us that, "it would be affirmed that all cars must have it installed? Apparently, Cranfield University in mandating technologies such as this one? To my unpracticed eye, it also question what actual free wellbeing repayment might the White House and Congress might go in England has prototyped a tale airbag technology to defend pedestrians hit by the U.S. Fiat is essentially no threshold to the features that can easily envisage such a badge having only be of course the guests rapidly to own 20% of Chrysler which is in the powers that This is why all Chryslers (and, or Fiats) are necessary to have a somewhat Rube Goldberg aspect to it.
link exchange
university admission
Post a Comment
<< Home