Medicine: Hints for Busy Doctors

Dr. Walter C. Alvarez, a famed internist at the Mayo Clinic — a tall, twinkly, immensely popular physician with a hard-boiled attitude toward illness — last week wrote a prescription for one of the prime problems of wartime medicine, too few doctors with too many civilian patients. The prescription offered by Dr. Alvarez in the A.M. A. Journal: dispose of patients faster by abler diagnosis. Its two chief ingredients: 1) distinguish between the really sick and the chronic complainers; 2) use a few. shrewd questions, which often yield a better diagnosis than elaborate laboratory tests.

Aches & Pains. “Pain is a common symptom of psychoneurosis.” When a pa tient announces that “she aches all over,” Dr. Alvarez begins to suspect that she is a bundle of nerves. His suspicion is confirmed if she is unable to tell him her main complaint, grumbles about trivialities, trembles, answers his questions irrelevantly, fails to let him finish a sentence.

Other practically sure signs of neurosis: fear of not being able to draw a deep breath, burning in the abdomen, repeated belching, stomachaches after “emotional debauches,” “distresses that come before breakfast.”

Heart and Arthritis. A pain above the stomach is sometimes diagnosed as a symptom of angina pectoris, peptic ulcer or gastritis, when the ailment actually is arthritis. If the pain does not come from fast walking, stair-climbing or anger, heart trouble can be ruled out; if there are no symptoms connected with eating, ulcers also are eliminated.

When the pain is a superficial ache or burning that gets worse when the patient sits or lies down, it is pretty sure to be arthritis or rheumatism. A simple way to tell arthritis from rheumatism is a blood sedimentation test: if the sedimentation rate is less than 10 mm. an hour, it is probably rheumatism.

Fatigue and Family. Many seemingly healthy people feel chronically tired with no apparent cause. Ask such patients: “Have any of your relatives suffered from mental disease, and particularly spells of depression?” If the answer is “Yes,” Dr.

Alvarez thinks it fairly certain that the patient is wearing herself out with footless worry.

Ulcer and Pseudo-Ulcer. Pseudo-ulcer is a fairly common condition. Many sup posed symptoms of stomach ulcer merely indicate an overly irritable digestive tract (which in many patients may be thrown out of kilter just by a drink of cold water).

A patient who vomits a little blood may simply have ruptured a small blood vessel after prolonged retching; if he really has a gastric hemorrhage from ulcer, he is likely to gush a pint of blood.

Allergies and Fuss-Budgets. Best way for a patient to find out whether he is allergic to certain foods (rather than a chronic dyspeptic) is to fast for a day or two; if he is allergic, his symptoms will quickly disappear. Patients who say they are allergic to eggs often give themselves away by eating them in cake without distress. A patient who asserts that he can eat nothing raw or nothing fried, etc., is usually “a fussy, opinionated person.” Migraine headache is one of the easiest diseases to identify. “All one has to do is to recognize the story of a throbbing, unilateral headache, followed by nausea and utter misery, or to see the miserable and apathetic patient in the attack.” The patient almost always has a “peculiar temperament”—nervous, hypersensitive, easily tired.