As a cardiologist I get to see a lot of patients either referred or self referral complaining of palpitations & chest pains for which many will eventually turn out to be negative for heart disease. Many times I can sense and pick them up the moment they come and start talking with their typical facies, body language, and overall demeanor....call it "SIXTH SENSE" if you may! These are some of the common things most doctors must observe their patient.
1. Typically young & middle aged female and less often males and the older age group. They are unaware that it is their heightened anxiety that is triggering all the " weird " manifestations that some feel as if it is the end of the world.
2. They may or may not have been seen by other doctors who has done tons of work up to them and all are negative. Since they have nothing else to give, they may prescribe medications like vitamin B complex or for some astute physicians may give them anxiolytic drugs.
3. I believe this has some genetic component because I still have to see an anxious patient with no family history of anxiety disorder. It is either the father or mother or both with the same problem....believe me! Patients typically suffer unconsciously from " Don't Ask, Don't Tell " policy....so if you as the doctor won't ask for these information typically patients don't seem to find this history important.
4. These patients are the most skeptical of all, so in order to fix them you need to understand that reassurance won't cut it out unless you prove to them that you have concrete basis for doing so. In my practice, I would typically do some routine things like physical exam, an office ECG and to some extent I find it necessary to do noninvasive work up like Echocardiogram and Exercise treadmill stress test. These tests I find it necessary to convince them that there is nothing wrong with their heart otherwise your advise won't hold water at all. For the severest forms I find counseling and with the help of anxiolytics help a lot.
5. In order for you to be successful at treating them you must: Talk, Sympathize, Understand and Intervene. A combination of all these are very effective in fixing the anxious patient. Their trust can only be heightened if you tell them how the anxious patient feel even before they start talking. More often than not they will start to realize that all the things you said are true and by this time your patient has gained your trust and are cured 80% of the time.
I can safely say that if doctors have the right skill and approach......only a few will end up requiring the help and intervention of a psychiatrist. Successful treatment needs the combination of physician understanding, counseling with lots of reassurance and sometimes with the help of anxiolytic medications.
