Susie Essman, aka Susie Greene of Larry David's HBO program, Curb Your Enthusiasm, has written a hilarious book (and yes, I actually read it) called What Would Susie Say?: Bullsh*t Wisdom About Love, Life and Comedy. For this week's CBS Doc Dot Com, I talked to Susie about some of her health issues covered in the book, including menopause, fear of germs, and hypochondria. "So far this month," she told me, "I've had Lyme disease, hysterical blindness, enlarged prostate...."
If any woman could actually have an enlarged prostate -- either her own or snatched in a fit of pique from her beleaguered television husband played by Jeff Garlin -- it would be Susie Greene. But as we discussed her real and imagined symptoms, it became clear that Susie Essman can be easily talked down from her flashes of hypochondriacal thinking. So she doesn't actually meet the official psychiatric definition of "hypochondriasis," in which a misinterpretation of symptoms leads to a preoccupation with having a serious illness that interferes with daily functions and lasts at least six months despite reassurances from a doctor. In fact, her belief that she's a hypochondriac is hypochondriacal.
True hypochondriasis can be a devastating illness but fortunately affects only about three percent of the population.
Many more of us -- just like Susie -- have occasional hypochondriacal thoughts that can be extremely challenging for doctors to address. As a physician, I do fear missing a serious illness in somebody who happens to be hypochondriacal. For me, the best approach has been to take complaints seriously, do a complete history and physical, and allow plenty of time for discussion. A patient who is convinced his day-old headache is from a brain tumor is not going to be reassured by "Oh, it's probably nothing" over the phone, especially if his friend just died of a cancer that was initially misdiagnosed. We'll both be relieved after his exam is normal and a conversation reveals he's been under extreme stress at work and, by the way, stopped drinking coffee two days ago. If symptoms persist I can always pursue further evaluation later.
Spending adequate time with patients is the best way to avoid unnecessary and expensive testing such as MRI's and CT scans, about a third of which are unnecessary.
Fortunately, my years of training and clinical experience have completely immunized me against hypochondriacal thinking. And I plan to set Susie straight about her prostate as soon as the pain from my ovarian cyst resolves.
Click here to watch Susie Essman discuss hypochondria, menopause, fear of germs, the teenage brain, intimacy in her marriage, the difference between men and women, what to look for in a man, and why she likes growing older. The clip ends with a very touching description of her grandmother Millie, who she adored.
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