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She was in her thirties, pale faced, tearful, agitated, , holding her head in her hands. I recognized her – It was her second visit with almost same complaints to the emergency department, in which I was working as a junior casualty medical officer. While giving her history she told me that she had similar episodes of throbbing head ach over the past several years. She also told me of having multiple other symptoms, such as pain in her legs, the rapid beating of the heart and abdominal pain in the past years, which no doctor had been able to determine the cause. After taking history and doing physical examination - that was unremarkable - I came to the conclusion that she was suffering from a somatoform disorder, a mental illness. I consulted my senior Casualty Medical Officer and gave her a painkiller injection - a common practice in that department to give symptomatic treatment to such patients without bothering to know the cause. After one hour she was symptom free. She thanked me and went away. When she left I felt guilty – a practice, one quits as one becomes old in our profession - it was not a proper way to deal with such a patient. I should have told her that she was suffering from somatoform disorder, not physical but a mental illness and she should consult a psychiatrist. But in our country to refer someone to a psychiatrist means you are thinking that person is mad. It was not easy to deal with, despite that I regretted for not guiding her properly. It is now a well known fact that a large proportion of patients visiting general out-patient departments or private clinics do not have organic disease requiring medical treatment.
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