Stress and Blurred Vision

For years I would teach medical residents about stress illness by telling the true story of a 16 year old girl who came to clinic with intermittent blurred vision (the full story is in my book).  I would ask them to pretend she was in the room and to try to diagnose the cause.  They would ask questions about her symptoms and “order” tests and I would give them the results.  Very few even got close to the answer though a few, to their credit, were able to look beyond physiology alone and figure out that her vision blurred when she was crying.  The crying was from severe depression brought on by regular physical abuse by her father.

The enormous clue that should have led my students to the answer was a large bruise on the girl’s neck caused when her father grabbed her by the throat and threw her against the wall a week earlier.  I always expected this to lead to questions about the young woman’s home life but instead, as soon as any physical connection between the bruise and her vision was ruled out, my students left the clue behind and explored other (unlikely) possibilities.  I used this case to teach for over 20 years and saw no improvement in the ability to solve the puzzle, confirming a gaping hole in medical education.

This is why I am particularly excited about speaking at UCLA on Saturday, mostly to mental health professionals, about how to diagnose stress illness.  If they can master the art, and I believe they can, and word of this reaches patients and their doctors, care of stress illness can at long last begin to transform.

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