“It must be a full moon—this patient has the weirdest symptom ever!” Kate, my intern, dropped into the chair across from me, looking haggard. We were early into the morning shift at our hospital’s walk-in clinic, where patients drop in with anything from runny noses to previously undiagnosed cancer, and already we were running late. Kate had been in with our second patient for 30 minutes. That was much longer than we had anticipated, since the reason the front-desk clerk had noted for his appointment was simply “hand problem.” Sounded innocuous enough. I asked Kate what the weird symptom was.
“He says his hands are possessed,” she said. “According to him, someone or something is forcing him to clench his hands—and he can’t make it stop. I couldn’t get him to quit talking about his possessed hands.” But Kate thought the patient’s delusional behavior was the least of his problems. “His legs are swollen and his lungs are full of fluid,” she explained. “I think he’s got some heart failure.”
As doctors, we’re all taught to pay attention to the chief complaint—the patient’s reason for coming to see the doctor—and to interpret what we find to explain it. In this case, though, Kate had astutely picked up on a potentially serious problem unrelated to the chief complaint, which sounded like something outside the bounds of the kind of medicine I practice.
