The Catch-All Diagnosis That Can Compromise Your Health
Cardiologist Tara Narula, MD, says some doctors are writing off more serious ailments too quickly, leaving patients at risk.
Photo: Adam Voorhes
It's all too easy to explain away health problems. You've been feeling run-down lately? You're probably just overworked. Or catching a cold. Or suffering from allergies. But one day you're leading a meeting at the office and suddenly grow so short of breath, you have to sit. You can no longer ignore the possibility that something is wrong, and you nervously make an appointment to see a doctor. As you describe your symptoms, you tell yourself, This is silly. I'm fine. The doctor checks your blood pressure, performs a few other simple tests and then says, "It's probably stress." But while it sounds reassuring, that simple phrase could actually compromise your health.
Early in medical training, doctors are taught to look for horses instead of zebras. It's a playful analogy to remind us that the most obvious diagnosis is usually the right one. Now that research and physicians understand more about the mind-body connection and the relationship between stress hormones and illness, the question "Are you stressed out?" has become part of initial patient assessments. And stress as a casual diagnosis is far more common. Yet when the spotlight is focused on stress, other more serious—and, in some cases, easily treatable—conditions can go unnoticed.
Take, for example, Marissa*, an energetic 38-year-old woman in a demanding career with a strict boss and constant deadlines. She had experienced several episodes in which her heart raced so rapidly that she felt nauseated and light-headed. She didn't take her symptoms seriously until she almost fainted on the subway after several minutes of intense heart palpitations. Trapped inside the moving train, she slumped down on the floor until the next stop. The minute she was back above ground, she called her doctor, who said, "Your stressful lifestyle is the problem." His prescription: "Relax, medicate, take up yoga—and find a new job." Then it happened again. Marissa was about to pass out in her office bathroom when a coworker found her and dialed 911. In the emergency room, I looked at Marissa's heart monitor and saw that her heart was beating at twice the normal rate and her blood pressure was very low, indicating she had an arrhythmia (a common disorder characterized by an irregular heart rhythm). I immediately referred her to a cardiac specialist, who performed a quick surgical procedure to treat the issue, and she was discharged two days later.
Marissa's case was fairly straightforward, but diagnosis is, unfortunately, not always that easy. Some diseases exhibit subtle symptoms, while others simultaneously affect several organ systems, making it difficult to pinpoint a single problem. Weight change, fatigue, nervousness or muscle aches could indicate stress, but they could also be symptoms of certain thyroid conditions. Diagnosing autoimmune diseases, such as lupus or rheumatoid arthritis, is notoriously difficult because they have symptoms that can look confoundingly like stress. Even certain neurological issues can manifest as routine headaches.
By the time I met Diane, a new mom with a 3-month-old baby, she had already seen several physicians and told her story multiple times, describing instances in which the left side of her face and body would go completely numb. "Everyone I've talked to thinks it's stress because my brain scan came back normal," she told me. "But I'm afraid I'm going to have a stroke. I can't have something happen to me when I'm alone with my child." After I reviewed Diane's medical history with a group of neurologists, I asked for a detailed account of her symptoms and learned that they occurred, alone with a severe headache, around her menstrual cycle. That suggested she might be suffering from a rare type of migraine. By treating the headaches, we solved the problem.
Why was my team able to make the connection when other doctors didn't? Many people suffer from stress-related migraines, so it's understandable how some physicians were inclined to reach that conclusion. But Diane's other symptoms were vital clues to the truth. To make a thorough diagnosis, a doctor has to listen to the whole story. If a symptom is frequent enough or severe enough that you're in the doctor's office—or you just have a gut feeling—your complaints should be taken seriously.
For your part, don't brush off a nagging problem until it gets worse. We all possess the priceless gift of intuition—it's invaluable in personal relationships and professional situations—but when it comes to health, patients dismiss it all too often. Help your doctor by providing as much information as possible about the symptoms you're experiencing: time of day, month, frequency, severity. We want any details you have, even if you think they're insignificant. The more information you give us, the more pieces of data we have to work with, and the more likely we are to get the diagnosis right.
*Patients' names have been changed.
Tara Narula, MD, is associate director of the Cardiac Care Unit at Lenox Hill Hospital/NSLIJ in New York City. She's a regular medical contributor for CBS This Morning.