Patients may mislead you to appraoch the diagnosis! True Case

[SOYDA]

The Aim of Medicine

The aim of modern medicine should be the “good life" as the Greeks understood the term. The fit body and the fit mind must go together. and to achieve this we should aim at complete mental, physical, and emotional development.
Unless we do this various phases of our personality are in different stages of development, and they will cause emotional instability and conflict within the personality and also with the Outside environment.

There are many physiological responses to emotional stimuli, probably associated with a pituitary dysfunction. But surely to treat merely the dysfunction of the pituitary is to treat only the symptoms of the disease and to leave the cause itself undiscovered and untreated. Similarly in the treatment of a peptic
ulcer the underlying cause should also be treated, otherwise the ulcer is apt to return. Also such metabolic disorders as atheroma and arteriosclerosis starting early in life, and essential hypertension, probably have a background of nervous stress and emotional frustration.
As any doctor who has worked in general practice knows, there is a close associate on between the antisocial or frustrated and the person suffering from subnormal health. These people already from a large proportion of any medical practice, and as more organic diseases are controlled they will form an
increasing percentage. There is a solid mass of chronic ill health among people leading unsatisfactory lives in rooms, hotels, and boarding-houses which will never be cured by orthodox methods.

I had an extreme case of social maladjustment and chronic ill health some time ago. A man of 47, physically fit, came to me complaining of psychological impotence. He was an intelligent man of some charm and culture, had always been, but became a heavy drinker and gambler. He lived apart from his wife and had had At least one illegitimate children for whom he had been astute enough to evade responsibility. His early history was as follows:
He was orphaned at an early age and joined a former regime in The 1970, then he participated the war in 1977, When his regiment was turned over to infantry he decided this would be too hard work for him. Unfortunately he was able to regurgitate and vomit at will, and he immediately decided to put this faculty to some practical use. He was admitted to hospital and literally vomited his way through nine different hospitals, and after eighteen months in hospital, having lost 3 st. in weight, he was discharged from the Army in 1985. He then carefully fed himself up and joined the social workers. Since treated him, this man has had a nervous breakdown, and his impotence has been sufficiently cured for the girl friend of the moment to have become pregnant.

How many men have been invalided from the Services in two wars as being psychologically unsuitable, with their neurotic and antisocial traits still untreated, to lead a life of ill-health or perversion causing trouble wherever they go ? We as doctors realize that emotional maturity is as essential as physical maturity for adult well-being, and until we are given facilities to treat these cases effectively there will be a great mass of sub healthy and mentally abnormal people in the country.


Executive Director of SOYDA
Dr.Abdiqani Shiekh Omar
somyoungdoctors@gmail.com,drabdiqani6@gmail.com

[Admin]

Yes, patient can mislead doctor, especially if he/she has "Munchausen syndrome".

It is a psychiatric disorder in which those affected fake disease, illness, or psychological trauma in order to draw attention or sympathy to themselves. It is in a class of disorders known as factitious disorders which involve "illnesses" whose symptoms are either self-induced or falsified by the patient. It is also sometimes known as hospital addiction syndrome.

These patients exaggerates or creates symptoms of illnesses in themselves in order to gain investigation, treatment, attention, sympathy, and comfort from medical personnel. In some extremes, people suffering from Munchausen's Syndrome are highly knowledgeable about the practice of medicine, and are able to produce symptoms that result in multiple unnecessary operations. For example, they may inject a vein with infected material, causing widespread infection of unknown origin, and as a result cause lengthy and costly medical analyses and prolonged hospital stay. The role of "patient" is a familiar and comforting one, and it fills a psychological need in people with Munchausen's.

I knew a lady with this disease, when she goes to every hospital she tells doctors that she is having renal colic and her urine turned red!, when doctors request urine sample, she adds few drops of blood to her urine... the doctors will send the sample to laboratory, the result come back with "Uncountable RBCs"... see how she managed to trick the doctors while she is melingering!!!

Also sometimes mentally stable patients especially "elders" can mislead doctors by giving vague history!!
When you ask them: what is your problem, what are you complaining of? they will tell you all the pains they had experienced in their entire life!!! or simply they can tell you in this way (Somali): ditoore meel ii fiyow maleh

So be aware of those who give Fake history as well as Vague history!!
Dr.Mahdi

[Pharmacist]

  too funny dr.mahdi, (ditoore meel ii fiyow maleh), So, how are you going to diagnose this old lady?

[Amal]

Munchausen syndrome , it is a kind of mental illness. like Dr mahdi said these people cause the symptoms, and its normally hard for care providers to proof the symptoms. One thing you forgot to address was that they all do this to get attention,
I remember one lady brought her child to the hospital, and exaggerated symptoms of surgical scars with inconsistent medical history. Finally the  docs were tired and through social worker, they were able to take the child away from the mother and the child seemed to be doing fine. If it happens to a child the best intevention is taking the child away from the mother!!!
Thanks for bringing that up Dr mahdi

[Waxbaro!]

too funny dr.mahdi, (ditoore meel ii fiyow maleh), So, how are you going to diagnose this old lady?

I think it's very important to explain to the patient how it's important their information is to reach your diagnosis and that in turn will effect their health.

So every doctor has his/her own way to deal with such situation.

& by the way, this is a common phrase used by elder people, and it's kind of searching sympathy and kindness and they believe that, the more they complain, the more doctors will pay much attention and solve their problems....

This is my suggestion: if someone said that to you, ask him/her this question? what about your mental status, is it affected too?!
Sure they will say: NO, Because in Somalia, it's a social stigma to reveal your mental instability.
Then next question is: if you are mentally stable then you should tell me, what are you complaining about?

Then he/she will tell you exactly what their problem is? try that, it worked for me!!!

Good Luck