Real-Life Decision Making
A family doctor calls you, a well-known rheumatologist, and tells you he'd like to refer a patient to you for further investigation. He says he suspects his patient may have lupus.
Lupus is an autoimmune disease. That means that the body's immune system attacks itself. "We don't know the origin or the cause of the disease," says Dr. Michael Maldonado. He is a rheumatologist. He specializes in autoimmune diseases.
Lupus is a particularly difficult disease to diagnose because it can manifest itself in so many different ways. "It can cause fevers, achiness, affect the skin, the eyes and in more severe cases, can attack the kidneys," he explains.
You agree to see the patient. She appears to be well. You examine and find no outward signs of anything wrong. You also note on her medical chart that she often complains that she has diseases that turn out to be nothing, and complains of illness that is not found by exams.
You talk to the patient about her condition. She tells you she hasn't been feeling well. But now she appears fine. "It happens all the time," she says. "There really is something wrong with me."
Could this woman just be dreaming up her symptoms? Is she simply a hypochondriac? You're a busy rheumatologist and have a long waiting list of patients who want to see you. What do you do?