werner@aecom.UUCP (Craig Werner) (01/18/86)
> A young woman comes into the clinic with (obviously) a health complaint. > > You ask what's wrong, and she says that her stomach hurts. > You ask her to describe the pain further, and you find that it > is worse before she eats breakfast. > You ask how long this has been going on, and she says it started to > bother her a few weeks ago, but has gotten worse recently. > You ask two more questions, the first of which is suggestive but > non-specific, the second of which suggests the obvious diagnosis? > > What is the informative question, and why do you ask? This was an actual situation. The next question asked followed up on the stomach (GI) symptoms, asking "Do you feel nauseous?" She didn't understand "nauseous." Rephrasing, "Do you feel like you're going to throw up?" She answered, "Sometimes." There was a slight pause as all the differential diagnosis of GI disease goes through your head, competing to be the next question, then all of a sudden, it dawns on you to forget about that and ask: "If I may ask, when was your last menstrual period?" She answered January, and this was in April. The diagnosis: morning sickness secondary to PREGNANCY. The interview continued for 10-15 minutes with eventual referral to family planning. When I tell this to friends, especially female, they invariably say, "How could she not have known she was pregnant?" My theory is that the power of denial cannot be underestimated. I was once told to remember three easy hints to catch the obvious: the most frequent cause of amennorhea is pregnancy, the most frequently found Suprapubic mass is a full bladder. One of my letters suggested an Ulcer. This would be a proper first guess in a man of 40, not a young woman. Also, ulcers tend to hurt most a few hours after each meal, not just in the morning. Note, however, that if she had NOT been pregnant, this would have to be considered. -- Craig Werner !philabs!aecom!werner "What do you expect? Watermelons are out of season!"
suze@terak.UUCP (Suzanne Barnett) (01/24/86)
> When I tell this to friends, especially female, they invariably say, > "How could she not have known she was pregnant?" My theory is that the power > of denial cannot be underestimated. Several years ago I was at a clinic getting a vaccination. I spoke with a nurse I knew, normal greetings and how is your day? type of things. She said they'd had a hectic day, a birth (births are not routinely handled there) where the mother was admitted to emergency with severe stomach pains (she was in labor and didn't even know she was pregnant). Apparently the woman had had a pregnancy test very shortly after getting pregnant, but it was negative, so she assumed she wasn't pregnant. My friend wondered what the woman could have possibly thought was happening to her for the past 9 months as she displayed all symptoms of pregnancy, also, how could others not have noticed and said something (especially her family)? I wondered too, it was certainly bizzarre. -- Suzanne Barnett-Scott uucp: ...{decvax,ihnp4,noao,savax,seismo}!terak!suze CalComp/Sanders Display Products Division 14151 N 76th Street, Scottsdale, AZ 85260 (602) 998-4800