“No Somos Robots.” The phrase comes to me first in Spanish because most of my primary care patients are monolingual Spanish speakers. But the concept is cross cultural. We are not robots. Even when we are healthy, we have minor and not so minor malfunctions.
Our very human bodies have all kinds of aches, pains, and sensations. My patients worry about feeling dizzy, neck pains, headaches, chest tightness, palpitations, abdominal bloating, pulsating leg veins, and dozens of other ailments. Often multiple ailments with symptoms that come and go. And not just my patients have these problems. My aging body also is prone to human frailties: my right shoulder and left knee ache. I get cramps in my calves at night so fierce I have to jump out of bed to stand up to relieve the pain.
For my patients, without a medical education, their pains and sensations scare them. In our visits, I listen carefully for distinctive patterns that fit a particular illness. I examine their bodies. I check basic laboratory tests looking for common problems like anemia or a slow thyroid. I might do an x-ray of an achy joint.
But often the history and physical and labs do not fit any pattern suggesting a disease. What then? No somos robots.
Some people are more sensitive to the sensations of their bodies than others. Some people shrug off pain. Some people are convinced pain means you have a serious illness. Anxiety makes all pain more intense, leading to a cycle where people experience pain, which leads to fear, leading to worsening pain. As I explain to my patients, often to their surprise, anxiety can cause almost any symptom in the body.
What I never tell my patients is that the symptoms are in their head. The symptoms are real, sometimes disabling. But that doesn’t mean that they have a treatable disease. I tell them, pointing to my gray hair, that I have taken care of many people with their symptoms, and that there is a difference between having symptoms and having a serious disease.
But what if I am wrong? What if I think that something is not serious and it is? Entirely possible. And in medicine there is always one more test to do. If an otherwise healthy person complains of palpitations, without passing out or falling, I listen to the heart and do an electrocardiogram. If both are normal, I stop. But what the palpitations are just not happening during the visit? Should I order a Holter, a box that you wear for 24 hours to record heart rhythms? And if that is negative, what about a 7-day monitor which can record your heart rhythm if you press a button when you feel palpitations? If that is normal, should you go to the electrophysiology lab where under anesthesia they can check for abnormal conduction pathways? The problem is that there is always a next test. Where do you stop?
And more testing is not without risks. False positive results can lead to unnecessary procedures and dangerous complications. And treatments of minor symptoms can occasionally lead to life threating complications.
I take great comfort in knowing that every disease has a natural progression. And as a primary care doctor, if I don’t diagnose the problem on this visit, I’ll diagnose it on the next. Continuity of care is our secret sauce. Often on the next visit, the symptom that my patient and I were worried about is gone, especially if I have successfully made my case that there is no serious disease present. But sometimes there’s a new symptom. The human body is glorious, but not flawless. No somos robots.
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