Hypochondria

[ADSigMel]

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Anybody else find that getting that all-important clinical experience before applying to medical school makes them hyper paranoid about their own health? I’m pretty sure I sprained a muscle in my mid-back a couple days ago. My list of differentials includes fracture, malignancy, and PE - like, my husband legit had to talk me out of going to the ER for a d-dimer!

If I’m going this crazy after a year of scribing, I hate to think what horrible things will cross my mind by the time residency rolls around! Anybody have any tips for dealing with this? Cognitive behavioral therapy or something? Lol

 

[dr_kateb]

Definitely avoid WebMD.

 

[Oso]

Don't come up with a differential for every minor problem that befalls you ...

 

[ADSigMel]

I feel like I know just enough to be dangerous - at least I’m only treating myself at this point, not patients. Still, the more I learn, the more terrified I get of bacteria, car accidents, and life in general. At some point, I’m gonna have to turn a corner or risk complete debilitation.

 

[ADSigMel]

Don't come up with a differential for every minor problem that befalls you ...

I’m not even in medical school yet - I shouldn’t be coming up with differentials under any circumstances. Just can’t help it. I’m honestly not even an anxious person in general, so this is Super out of character for me.

 

[curbsideconsult]

I really try to avoid saying this but I think it's apt in your case: you'll be fine. If your "hypochondria" gets to the point where you're going to see the doctor every week and it's interfering with your studies, then yes you have a big problem. Up until that point, you're just a neurotic like the rest of us. I'm pretty sure I've had a mild form of every disease/disorder we've studied in the last nearly two years. I miraculously recover at the end of each block.

 

[ciestar]

Wait until you start medical school. It gets worse.

 

[DBC03]

I hate to admit this, but I just finished listening to a medical microbiology class and I actually feel no additional urge to wash my hands. I realize how much bacteria is out there and it doesn't phase me. I mean, shouldn't I at least be a tad more paranoid at this point?

 

[ciestar]

I hate to admit this, but I just finished listening to a medical microbiology class and I actually feel no additional urge to wash my hands. I realize how much bacteria is out there and it doesn't phase me. I mean, shouldn't I at least be a tad more paranoid at this point?

Micro doesn’t really make me paranoid at all. It is pathology/pathophys. Every block there are so many new things I am convinced I am going to die of since i had symptom X ten years ago.

 

[SpoiledMilk]

I'm sure that after taking Torts, you were hyper vigilant about seeing negligence in everything. I suppose it will get worse before it gets better in medschool.

 

[getdown]

Anybody else find that getting that all-important clinical experience before applying to medical school makes them hyper paranoid about their own health? I’m pretty sure I sprained a muscle in my mid-back a couple days ago. My list of differentials includes fracture, malignancy, and PE - like, my husband legit had to talk me out of going to the ER for a d-dimer!

If I’m going this crazy after a year of scribing, I hate to think what horrible things will cross my mind by the time residency rolls around! Anybody have any tips for dealing with this? Cognitive behavioral therapy or something? Lol

The problem is that you're an ER scribe and thus picked up on the ER physician mindset of ruling out all the potential killers first. And like you said you know just enough to make the wrong conclusions but not enough to put it all in context. It's ok, that's what medical school, residency and fellowship training is for. However, once you start medical school you're going to have to retrain your thinking to rule in and rule out differentials according to what is most likely. Remember the saying "when you hear hoof beats, think horses not zebras" first unless of course you're in an African safari.

A few teaching points for those interested:
For what it's worth, a d-dimer is not helpful. It's elevated in many chronic diseases. Taken with everything else it can confirm the presence of PE but by itself is not diagnostic. You'd get a spiral CT as the gold standard.
If you're concerned about a PE you'd likely see pleuritic chest pain or pain with inspiration as a key symptom not just pain in the back as well as shortness of breath.
If you had pain radiating to the back, you'd likely put an aortic dissection to be higher in the differential though less likely in a healthy, non-hypertensive young female.
A fracture is more likely but in the absence of trauma probably less likely. Fractures would most likely have point tenderness when pressing on the bone that's fractured
Malignancy also lower on differential in the absence of continued unintentional weight loss in a otherwise healthy young female

 

[AnatomyGrey12]

I feel like I know just enough to be dangerous - at least I’m only treating myself at this point, not patients. Still, the more I learn, the more terrified I get of bacteria, car accidents, and life in general. At some point, I’m gonna have to turn a corner or risk complete debilitation.

Lol just wait until you actually know medical stuff....

Micro doesn’t really make me paranoid at all. It is pathology/pathophys. Every block there are so many new things I am convinced I am going to die of since i had symptom X ten years ago.

Same, I'm convinced I have a liver tumor 🤣🙁

 

[ciestar]

Lol just wait until you actually know medical stuff....



Same, I'm convinced I have a liver tumor 🤣🙁

Psych was the worst of them all, though.....

 

[Goro]

Anybody else find that getting that all-important clinical experience before applying to medical school makes them hyper paranoid about their own health? I’m pretty sure I sprained a muscle in my mid-back a couple days ago. My list of differentials includes fracture, malignancy, and PE - like, my husband legit had to talk me out of going to the ER for a d-dimer!

If I’m going this crazy after a year of scribing, I hate to think what horrible things will cross my mind by the time residency rolls around! Anybody have any tips for dealing with this? Cognitive behavioral therapy or something? Lol

Welcome to Young Intern's Disease.

 

[RTC19]

Anybody else find that getting that all-important clinical experience before applying to medical school makes them hyper paranoid about their own health? I’m pretty sure I sprained a muscle in my mid-back a couple days ago. My list of differentials includes fracture, malignancy, and PE - like, my husband legit had to talk me out of going to the ER for a d-dimer!

If I’m going this crazy after a year of scribing, I hate to think what horrible things will cross my mind by the time residency rolls around! Anybody have any tips for dealing with this? Cognitive behavioral therapy or something? Lol

This is a very common thing that happens to people upon exposure to sick people on a regular basis. I think you just realize how fragile life is and that there are tragedies everywhere and that they can happen to anyone once you are in clinical settings and see these people who have been the victims of awful luck.

FWIW, I lost a neighbor girl I was friends with growing up to brain cancer when we were 22 and now I can't get a severe headache or have a seizure after a good seizure-free period (I have had epilepsy since I was a toddler) without thinking I must have a brain tumor and I am going to become H. Hospice volunteering-even though I generally love it-didn't help with this either. I took care of a guy who wasn't much older than me at all, had a wife and three beautiful little girls at home and was on service for terminal cancer.

I think you just have to remember and remind yourself that life-threatening causes of common medical symptoms (back pain for you, headaches for me) are statistically very rare. Additionally, people who present with seemingly common symptoms that turn out to have something terrible often have other symptoms most people would know are especially concerning. For example, my friend had bad vision changes in addition to the headache that she complained of when she went to the ER and got diagnosedwith a big brain tumor.

And +1 to what the attending up above said about you picking up on the emergency physician mentality of worrying about the life-threatening stuff first before attempting to rule in what it is most likely to be (i.e. you moved your back funny or lifted something too heavy for you and have a sprain. Some acetaminophen/ibuprofen, rest, a heating pad/ice and treating yourself to ice cream and Netflix should fix that right up in a few days with no doctor visit required).

 

[ADSigMel]

I'm sure that after taking Torts, you were hyper vigilant about seeing negligence in everything. I suppose it will get worse before it gets better in medschool.

Very true - I was repeating “Duty, Breach, Causation, Damages” before making just about any decision for my whole first year of law school. Then I started taking employment law classes, which was the field I actually ended up in, and the whole calculus changed.

The problem is that you're an ER scribe and thus picked up on the ER physician mindset of ruling out all the potential killers first. And like you said you know just enough to make the wrong conclusions but not enough to put it all in context. It's ok, that's what medical school, residency and fellowship training is for. However, once you start medical school you're going to have to retrain your thinking to rule in and rule out differentials according to what is most likely. Remember the saying "when you hear hoof beats, think horses not zebras" first unless of course you're in an African safari.

A few teaching points for those interested:
For what it's worth, a d-dimer is not helpful. It's elevated in many chronic diseases. Taken with everything else it can confirm the presence of PE but by itself is not diagnostic. You'd get a spiral CT as the gold standard.
If you're concerned about a PE you'd likely see pleuritic chest pain or pain with inspiration as a key symptom not just pain in the back as well as shortness of breath.
If you had pain radiating to the back, you'd likely put an aortic dissection to be higher in the differential though less likely in a healthy, non-hypertensive young female.
A fracture is more likely but in the absence of trauma probably less likely. Fractures would most likely have point tenderness when pressing on the bone that's fractured
Malignancy also lower on differential in the absence of continued unintentional weight loss in a otherwise healthy young female

Thank you - you’re my new voice of reason!

 

[ADSigMel]

FWIW, I lost a neighbor girl I was friends with growing up to brain cancer when we were 22 and now I can't get a severe headache or have a seizure after a good seizure-free period (I have had epilepsy since I was a toddler) without thinking I must have a brain tumor and I am going to become H. Hospice volunteering-even though I generally love it-didn't help with this either. I took care of a guy who wasn't much older than me at all, had a wife and three beautiful little girls at home and was on service for terminal cancer.

I’ve had migraines since I was 8. Only since scribing have I been hearing phantom “pop”s and telling my husband that I just sprung a leak and am now bleeding into my brain. But I haven’t died yet, so that helps a lot with helping me internalize how ridiculous I’m being. Once my back pain goes away in a couple of days, I hope to look back on my imaginary embolism and laugh (just not in front of patients who really have them - that would be rude).

 

[Oso]

At least you're not alone, OP. I'm afraid the only advice I have for you and everyone else with similar worries is:

Live like there's no tomorrow!

Because there's probably not.

Because you probably have Lupus.

And Kikuchi histiocytic necrotizing lymphadenitis.

Don't google it.

 

[Oso]

I said don't google it!

 

[willow84]

My DR always tells me that the only online sources I should ever look at should include a ".org or a .edu" at the end. That has only kind of helped me... haha

 

[PTPoeny]

It will get worse before it gets better. Although there is some solace in basically your entire class worrying about the same rare disease at the same time. A good trusted primary care doctor will help. Someone you feel comfortable saying, I know it is silly but I am worried about x,y,z even though it is probably just something little. My doctor in med school was happy to answer emails (through the emr so it didn't feel like overstepping) and say come in if you have a,b,c symptoms or your current symptoms last longer than d time. And he would share the freak outs that he himself had during medical school. It does get better, for me it was hard to put the rare stuff into perspective during the first two years but during the second half of medical school and residency you get to develop a better sense of how much more common the common things are and a better sense of warning signs and what they actually look like.