Practitioner April 2010 – 254 (1728):46

Why is your patient worried sick?

15 Apr 2010


Professor David Haslam CBE FRCGP
GP, Ramsey, Cambridgeshire; Past President RCGP; national clinical adviser to the Healthcare Commission; and Visiting Professor at de Montfort University, Leicester


I've always been intrigued by the way that medical conditions so often become the source of everyday phrases and sayings. Can there be a better description of irritable bowel syndrome than worry guts? What about phrases such as worried sick, or butterflies in the tummy?

One of the great difficulties with trying to explain the emotional causes of many medical conditions to patients is that the moment we start to talk about the impact of their nerves, they begin to think that we don't really believe that they are suffering. Patients all too often become convinced that we think that they are imagining their symptoms. They know that they get this dreadful pain. We insist on telling them that the cause is anxiety. How can these two extremes possibly add up? It's no wonder that patients disappear off to alternative therapists who find their skin to be sadly lacking in molybdenum - a far more acceptable explanation of their pain than our ridiculous theory.

I was consulted last week by a lady who was complaining volubly for the umpteenth time about the dreadful and recurrent sensation of nausea that is ruining her life. Over the past few years I have done absolutely everything I can to make sure there isn't a treatable underlying cause, but whatever I do she never seems to be reassured in the least. She has seen a neurologist who scanned everything in sight. She has seen an ENT surgeon who arranged tests I've never heard of for conditions I didn't know existed, and proved that she didn't have them. Most recently she has seen a gastroenterologist for an endoscopy, and wasn't in the least reassured to be told that it was normal too. The specialist had told her that it was her nerves, and she thought he was talking nonsense.

And so, rather later than was ideal, we started to talk about the rest of her life. Her husband had apparently lost his job some months ago, and money was extremely tight. Her mother lived several hundred miles away, and had recently been unwell. Visiting was nearly impossible, and not visiting made her feel guilty.

And to cap it all, her son had recently been in trouble with the law.

I listened, and then said: ‘That's a fair amount you've got to deal with. You must be worried sick.' I waited and the penny dropped. Much to my astonishment and delight she smiled and said: ‘I see what you mean.' If this column were fiction,

I would tell you that her symptoms cleared up that moment, but it isn't, and they didn't, but at least she felt better about taking the metoclopramide and understood the explanation.

It's a technique that I use frequently. Have you noticed how often people with cervical spine problems are faced with more than their fair share of stress? You can listen to their tale of woe, and then say something like ‘that sounds like a real pain in the neck'. It's a phrase everyone understands, and allows you to explain that phrases like this didn't occur by accident. There really is a well recognised link between emotional tension and neck muscle tension.

The list of similar phrases is extraordinarily long, including brokenhearted, breathless with excitement, emotions that make you choked up, and relatives who are a headache, but it probably doesn't include taking the mick.

I discovered a while back that this was actually a polite shortening of a different well known phrase, turning it from its Anglo-Saxon four letter version to a more polite medical term - taking the micturition. It's as good a story as any!