For all my interactions with people with chronic illness, I have never interacted with a chronically ill hypochondriac -- that is, someone who IS sick but invents additional symptoms or catastrophizes their existing ones. CW/TW: gaslighting. A THREAD. #MedTwitter (1/15) https://twitter.com/whatcolorbird/status/1319317973576916998

I've met one or two healthy people with a morbid fear of ~becoming~ ill, but they don't invent symptoms: they worry they'll catch things. "This milk is one day off -- what if I get botulism?" Their fear is oriented to the possibility of one day becoming ill. (2/15)

But there is one person whom I know who everyone believes to be a hypochondriac though I strongly believe she is not. And it breaks my heart every time I think about it. (3/15) #neisvoid

She was the textbook picture of a post-Freudian "nervous hysteric": thin, fluttery, middle-aged, female-presenting. Once I sat her down and we discussed her symptoms. It was clear to me that she had something serious, chronic, and neurological going on. (4/15) #MedStudentTwitter

Likely post-infectious, but not ME.
She had theories about why she was doing so poorly. Much of what she said was science-adjacent, but was not good science. (5/15)

We talked through her symptoms and she asked for my opinion. I said I really wasn't sure of her ultimate diagnosis, but she might try some supportive things for overall neuro function. I promised to give some information to her son, whom I knew better, later on. (6/15)

When I talked to her son, though, he was furious. "How could you encourage her?" he said. And like a movie flashback, I suddenly saw how her son & husband treated her in all my memories. Like she was a child, or an idiot. (7/15) #neisvoid

I thought: something is wrong with her, but because she doesn't have the right words to describe it, she's going to be gaslit & shunned, indefinitely.
I asked him if he would give her the information she'd asked for.
Disgusted, he told me he would not. (8/15) #neisvoid

You might wonder if I was handing him information on crystal therapy, or tapeworms, or healing prayer. But of course,
a) I was not
b) he had no idea what info I was giving him because he didn't look at it
What offended him was that someone had taken his mother seriously. (9/15)

There are probably many women whose gentleness made them easier for doctors and loved ones to dismiss. Women who did not study the sciences so can only describe their experience phenomenologically. I don't know why it's so hard to understand that they can still be sick. (10/15)

Your patient may seem manic if you're the first person she has really spoken to about her illness. Your patient may sob if she feels terrified & alone. Your patient may repeat herself or give unusually long pauses in her speech if her disease is neurological. (11/15) #MedTwitter

Being articulate & professional in the doctor's office means NOTHING about the patient's right to the diagnostic process. "CREDIBILITY" CAN GO HANG. THE SYMPTOMS ALONE ARE MEANINGFUL. (12/15)

For too many clinicians, the first step in the diagnostic process is gauging the patient's credibility: what is the patient's emotional state? do they speak 'my language'? do they also fawn/feign ignorance at the right moment so I still feel in charge? (13/15) #MedStudentTwitter

On the part of the patient, playing this game well requires a degree of focus that is likely beyond the ability of someone with processing problems like our lady in question. And it's human to be frustrated, grieving, or angry at being treated this way -- and to show it. (14/15)

So much of medical malfeasance/negligence rests on the foundation that women are not reliable reporters of their own experience -- and that there is a "certain type of woman" who tends to exaggerate for attention. Kill this with fire, please. (15/15)

What really got me was the way that her husband and son actively prevented her from access to information. Perhaps they feared it would "encourage" her to be ill, but I couldn't help thinking they really wanted her to serve their needs & stop being such a bother. (16/15)

*and such an ~embarrassment~.
Son was a programmer and, I think, deeply humiliated by his mother's non-sciency discussions about her illness.

For the men who hate chronic illness the most, there is almost ALWAYS a mom, auntie, or grandma who did not make him the center of her world because she was too ill to do so. He feels cheated and angry and, well... you know the rest.

Adding this thread, for Reasons: https://twitter.com/exceedhergrasp1/status/1278795414817239041